Provider Demographics
NPI:1891861902
Name:ABOVE PAR PC
Entity Type:Organization
Organization Name:ABOVE PAR PC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-685-6985
Mailing Address - Street 1:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-1202
Mailing Address - Country:US
Mailing Address - Phone:307-670-0464
Mailing Address - Fax:307-459-6965
Practice Address - Street 1:501 E LAKEWAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6416
Practice Address - Country:US
Practice Address - Phone:307-685-6985
Practice Address - Fax:307-685-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY332B00000X
WY52035623336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114706401Medicaid
WY114706400Medicaid
1891861902OtherNPI
WY5203562OtherSTATE PHARMACY LICENSE
WY5203562OtherSTATE PHARMACY LICENSE