Organization
STAR VALLEY DRUG CO
Active
Other names
LOWER VALLEY DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL STAUFFER (PRESIDENT)
(307) 885-9804
Entity
Organization
Contact information
Practice address
190 N MAIN, THAYNE, WY 83127-1006
(307) 883-4600
Mailing address
PO BOX 1006, 190 N MAIN, THAYNE, WY 83127-1006
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
5203031
WY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0028895
—
WY
05
—
110016500
—
WY
01
—
5203031
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/06/2006
Last updated
06/18/2008
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