Individual
SHANNON RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1456 SOUTH ST, WHEATLAND, WY 82201-2736
(307) 322-2486
Mailing address
72 KANSAS ST, CHEYENNE, WY 82009-8917
(910) 546-2395
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4183
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4183
WYOMING BOP PHARMACIST LICENSE
WY
Enumeration date
11/07/2019
Last updated
11/07/2019
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