Provider Demographics
NPI:1912462326
Name:UINTA DRUG PHARMACY
Entity Type:Organization
Organization Name:UINTA DRUG PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:307-786-2222
Mailing Address - Street 1:2822 HIGHWAY 414
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-9135
Mailing Address - Country:US
Mailing Address - Phone:307-786-2222
Mailing Address - Fax:866-846-7151
Practice Address - Street 1:2822 WY 414
Practice Address - Street 2:STE C
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-786-2222
Practice Address - Fax:866-846-7151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH LINCOLN HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy