Provider Demographics
NPI:1356560742
Name:REGISTER CLIFF PHARMACY, INC.
Entity type:Organization
Organization Name:REGISTER CLIFF PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:307-836-9270
Mailing Address - Street 1:437 W WHALEN ST
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:GUERNSEY
Mailing Address - State:WY
Mailing Address - Zip Code:82214
Mailing Address - Country:US
Mailing Address - Phone:307-836-9270
Mailing Address - Fax:307-836-9275
Practice Address - Street 1:437 W WHALEN AVE
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214
Practice Address - Country:US
Practice Address - Phone:307-836-9270
Practice Address - Fax:307-836-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52822143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY4858640001Medicare ID - Type Unspecified