Provider Demographics
NPI:1982465027
Name:ZOLLER, BEN (RPH)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:ZOLLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ANGEL LN
Mailing Address - Street 2:
Mailing Address - City:PAVILLION
Mailing Address - State:WY
Mailing Address - Zip Code:82523-9717
Mailing Address - Country:US
Mailing Address - Phone:307-840-5393
Mailing Address - Fax:
Practice Address - Street 1:511 N 12TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3805
Practice Address - Country:US
Practice Address - Phone:307-856-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist