Provider Demographics
NPI:1972717577
Name:DAVE'S DRUG PARTNERSHIP
Entity Type:Organization
Organization Name:DAVE'S DRUG PARTNERSHIP
Other - Org Name:DAVE'S HOME OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-322-3425
Mailing Address - Street 1:1452 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3232
Mailing Address - Country:US
Mailing Address - Phone:307-322-3425
Mailing Address - Fax:307-322-3719
Practice Address - Street 1:1452 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3232
Practice Address - Country:US
Practice Address - Phone:307-322-3425
Practice Address - Fax:307-322-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYR10004332BX2000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1066200-01Medicaid
WY0883890001Medicare NSC