Provider Demographics
NPI:1932587466
Name:ROSENQUIST, DANA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:ROSENQUIST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:4308 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5508
Mailing Address - Country:US
Mailing Address - Phone:307-745-6112
Mailing Address - Fax:307-721-4975
Practice Address - Street 1:4308 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5508
Practice Address - Country:US
Practice Address - Phone:307-745-6112
Practice Address - Fax:307-721-4975
Is Sole Proprietor?:No
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist