Provider Demographics
NPI:1912107921
Name:SHILLCOX, CHRYSTANNE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:CHRYSTANNE
Middle Name:LYNN
Last Name:SHILLCOX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 HIGHWAY 150 SOUTH
Mailing Address - Street 2:PO BOX 177
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930
Mailing Address - Country:US
Mailing Address - Phone:307-789-3464
Mailing Address - Fax:307-789-3660
Practice Address - Street 1:831 HIGHWAY 150 SOUTH
Practice Address - Street 2:WYOMING STATE HOSPITAL PHARMACY
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:307-789-3660
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2508183500000X
CO12877183500000X
UT56840651701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist