Provider Demographics
NPI:1740424332
Name:STRALEY, MONTE WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MONTE
Middle Name:WILLIAM
Last Name:STRALEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MONTE
Other - Middle Name:W
Other - Last Name:STRALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:727A WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701
Mailing Address - Country:US
Mailing Address - Phone:307-746-2425
Mailing Address - Fax:307-746-3724
Practice Address - Street 1:727 A WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701
Practice Address - Country:US
Practice Address - Phone:307-746-2425
Practice Address - Fax:307-746-3724
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3407183500000X
IDP49421835P0018X
IDCS56121835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3407OtherWYOMING BOARD OF PHARMACY
IDCS5612OtherIDAHO STATE BOARD OF PHARMACY
IDP4942OtherIDAHO STATE BOARD OF PHARMACY