Organization
HILLSIDE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIRGIL VIRCHOW (PHARMACIST/OWNER)
(307) 283-3883
Entity
Organization
Contact information
Practice address
224 MAIN STREET, SUNDANCE, WY 82729-0547
(307) 283-3883
(307) 283-3884
Mailing address
PO BOX 547, SUNDANCE, WY 82729-0547
(307) 283-3883
(307) 283-3884
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5201013
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106755900
—
WY
Enumeration date
10/23/2006
Last updated
06/19/2008
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