Provider Demographics
NPI:1790093839
Name:ANDERSEN, NANCY SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUSAN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4744
Mailing Address - Country:US
Mailing Address - Phone:307-362-1841
Mailing Address - Fax:307-382-2197
Practice Address - Street 1:2531 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4744
Practice Address - Country:US
Practice Address - Phone:307-362-1841
Practice Address - Fax:307-382-2197
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist