Organization
BUFFALO PRESCRIPTION SHOP, INC
Active
Other names
Buffalo Prescription Shop
Organization subpart
No
Provider details
NPI number
Authorized official
TOM ALLEN MAERTENS RPH. (OWNER/PHARMACIST-IN-CHARGE)
(307) 684-7003
Entity
Organization
Contact information
Practice address
431 FORT ST, BUFFALO, WY 82834-1805
(307) 684-7003
(307) 684-7348
Mailing address
431 FORT ST, BUFFALO, WY 82834-1805
(307) 684-7003
(307) 684-7348
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5200112
WY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106888100
—
WY
01
—
2111130
PK
—
Enumeration date
11/03/2006
Last updated
10/22/2018
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