Provider Demographics
NPI:1801294319
Name:CAVANAUGH, DUSTIN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4956
Mailing Address - Country:US
Mailing Address - Phone:307-634-7433
Mailing Address - Fax:
Practice Address - Street 1:2032 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4956
Practice Address - Country:US
Practice Address - Phone:307-634-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist