Provider Demographics
NPI:1992477889
Name:WITHERS, JERRY EUGENE III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:EUGENE
Last Name:WITHERS
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7216 SAY KALLY RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5735
Mailing Address - Country:US
Mailing Address - Phone:307-286-6782
Mailing Address - Fax:
Practice Address - Street 1:7121 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2651
Practice Address - Country:US
Practice Address - Phone:307-637-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY4333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist