Provider Demographics
NPI:1841331709
Name:HNA, INC.
Entity type:Organization
Organization Name:HNA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-877-4209
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-1001
Mailing Address - Country:US
Mailing Address - Phone:307-877-4209
Mailing Address - Fax:307-877-6254
Practice Address - Street 1:620 PINE AVE
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3002
Practice Address - Country:US
Practice Address - Phone:307-877-4209
Practice Address - Fax:307-877-6254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HNA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
WY5202988333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5202988OtherOTHER ID NUMBER-COMMERCIAL NUMBER
109341000Medicare ID - Type Unspecified