Organization
SOUTH STREET PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORINDA L GEILE RPH (PRESIDENT/OWNER)
(307) 322-2486
Entity
Organization
Contact information
Practice address
1456 SOUTH ST, WHEATLAND, WY 82201-2736
(307) 322-2486
Mailing address
1456 SOUTH ST, WHEATLAND, WY 82201-2736
(307) 322-2486
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
R10063
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129737600
—
WY
Enumeration date
07/20/2010
Last updated
08/21/2013
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