Provider Demographics
NPI:1962718692
Name:VETERANS AFFAIRS MEDICAL CENTER
Entity type:Organization
Organization Name:VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT, BS
Authorized Official - Phone:307-760-4867
Mailing Address - Street 1:5709 EDUCATION DR
Mailing Address - Street 2:APARTMENT 307
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3951
Mailing Address - Country:US
Mailing Address - Phone:307-760-4867
Mailing Address - Fax:
Practice Address - Street 1:5709 EDUCATION DR
Practice Address - Street 2:APARTMENT 307
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3951
Practice Address - Country:US
Practice Address - Phone:307-760-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA