Organization
OSBACK PHARMACEUTICALS INC
Active
Other names
Palace Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JOLENE OSBACK PHARMD (OWNER)
(307) 332-2270
Entity
Organization
Contact information
Practice address
634 MAIN ST, LANDER, WY 82520-3034
(307) 332-2270
(307) 332-6007
Mailing address
634 MAIN ST, LANDER, WY 82520-3034
(307) 332-2270
(307) 332-6007
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10054
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103910501
—
WY
01
—
2120702
PK
—
Enumeration date
11/09/2006
Last updated
08/30/2016
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