Provider Demographics
NPI:1881095966
Name:SMITH'S FOOD AND DRUG PHARMACY #187
Entity type:Organization
Organization Name:SMITH'S FOOD AND DRUG PHARMACY #187
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RESHA
Authorized Official - Middle Name:ASHLY
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:307-875-7841
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty