Provider Demographics
NPI:1396164489
Name:MYERS, PATRICA (RPH)
Entity type:Individual
Prefix:MS
First Name:PATRICA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 COFFEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5761
Mailing Address - Country:US
Mailing Address - Phone:307-674-7417
Mailing Address - Fax:307-674-7410
Practice Address - Street 1:1695 COFFEEN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5761
Practice Address - Country:US
Practice Address - Phone:307-674-7417
Practice Address - Fax:307-674-7410
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist