Individual
JADE ENEVOLDSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
4308 E GRAND AVE, LARAMIE, WY 82070-5508
(307) 745-6112
(307) 721-4975
Mailing address
4308 E GRAND AVE, LARAMIE, WY 82070-5508
(307) 745-6112
(307) 721-4975
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3784
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3784
PHARMACIST LICENSE
WY
Enumeration date
10/28/2014
Last updated
10/28/2014
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