Organization
TETON COUNTY HOSPITAL DISTRICT
Active
Parent organization
TETON COUNTY HOSPITAL DISTRICT
Other names
St John's Medical Center Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
TETON COUNTY HOSPITAL DISTRICT
Authorized official
ALISA JEAN LANE (DIRECTOR OF FINANCE)
(307) 739-7641
Entity
Organization
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001-8642
(307) 739-6172
(307) 739-7698
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-6172
(307) 739-7698
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
5201102
WY
3336L0003X
Long Term Care Pharmacy
5201102
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106299907
—
WY
Enumeration date
01/23/2007
Last updated
12/19/2017
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