Provider Demographics
NPI:1295986875
Name:PAXTON, GERALD LYNN (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:LYNN
Last Name:PAXTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 BRIDGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-5879
Mailing Address - Country:US
Mailing Address - Phone:307-875-7841
Mailing Address - Fax:307-875-0166
Practice Address - Street 1:905 BRIDGER DR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5879
Practice Address - Country:US
Practice Address - Phone:307-875-7841
Practice Address - Fax:307-875-0166
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY103142-253OtherDRIVERS LICENSE NUMBER