Active NPI
Laraine Jeffery
- Compounded Sterile Preparations Pharmacist
- Cheyenne, WY
National Provider Identifier
1053884114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Compounded Sterile Preparations Pharmacist
- License
- 4063
- Practice address
- 2360 E Pershing Blvd
Cheyenne, WY 82001-5356 - Phone
- (307) 778-7550
- NPI assigned
- Jan 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 4063 | WY | |
| Compounded Sterile Preparations Pharmacist | 1835C0207X | 4063 | WY | Primary |
Addresses
Primary practice location
2360 E Pershing Blvd
Cheyenne, WY 82001-5356
Mailing address
2360 E Pershing Blvd
Cheyenne, WY 82001-5356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4063 | WY | MD | Medical license number |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722556800000",
"number": "1053884114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2360 E PERSHING BLVD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820015356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2360 E PERSHING BLVD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820015356",
"telephone_number": "307-778-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERY",
"first_name": "LARAINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-10",
"last_updated": "2024-08-02",
"certification_date": "2024-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "WY",
"license": "4063",
"primary": false
},
{
"code": "1835C0207X",
"taxonomy_group": "",
"desc": "Pharmacist, Compounded Sterile Preparations",
"state": "WY",
"license": "4063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.