Individual
DR. COLTER JESS HADERLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
679 S WASHINGTON ST, AFTON, WY 83110-6000
(307) 885-9804
(307) 885-9760
Mailing address
679 S WASHINGTON ST, AFTON, WY 83110-6000
(307) 885-9804
(307) 885-9760
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3575
WY
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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