Organization
TETON COUNTY HOSPITAL DISTRICT
Active
Parent organization
TETON COUNTY HOSPITAL DISTRICT
Other names
St. John's Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
TETON COUNTY HOSPITAL DISTRICT
Authorized official
ALISA LANE (DIRECTOR OF FINANCE)
(307) 739-7641
Entity
Organization
Contact information
Practice address
555 E BROADWAY AVE STE 212, JACKSON, WY 83001-8640
(307) 739-7656
(307) 739-7658
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7656
(307) 739-7658
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
R10167
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R10167
STATE LICENSE NUMBER
WY
Enumeration date
07/13/2017
Last updated
07/21/2022
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