Organization
EMISSARY PROFESSIONAL GROUP
Active
Other names
EMISSARY HMO PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY RENZ RPH (OWNER)
(307) 472-0597
Entity
Organization
Contact information
Practice address
2546 E 2ND ST, BLDG 100, CASPER, WY 82609-2062
(307) 237-7751
(307) 237-7448
Mailing address
2546 E 2ND ST, BLDG 100, CASPER, WY 82609-2062
(307) 237-7751
(307) 237-7448
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
Primary
52-03586
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5203586
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/07/2008
Last updated
10/06/2010
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