Provider Demographics
NPI:1851997076
Name:UPTON PHARMACY
Entity Type:Organization
Organization Name:UPTON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-746-3742
Mailing Address - Street 1:1124 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 PINE ST.
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:WY
Practice Address - Zip Code:82730
Practice Address - Country:US
Practice Address - Phone:307-746-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTON COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy