Active NPI
Carolyn Komosinski Peavey, PHARM D
- Pharmacist
- Green River, WY
National Provider Identifier
1104077783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 3200
- Practice address
- 905 Bridger Dr
Green River, WY 82935-5879 - Phone
- (307) 875-7841
- Fax
- (307) 875-0166
- NPI assigned
- Oct 1, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3200 | WY | Primary |
Addresses
Primary practice location
905 Bridger Dr
Green River, WY 82935-5879
Mailing address
905 Bridger Dr
Green River, WY 82935-5879
Phone (307) 875-7841
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109029-371 | Other | WY | DRIVER'S LICENSE |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3200 | WY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1104077783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 BRIDGER DR",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829355879",
"telephone_number": "307-875-7841",
"fax_number": "307-875-0166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 BRIDGER DR",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829355879",
"telephone_number": "307-875-7841",
"fax_number": "307-875-0166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEAVEY",
"first_name": "CAROLYN",
"middle_name": "KOMOSINSKI",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-01",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WY",
"license": "3200",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER'S LICENSE",
"identifier": "109029-371",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green River, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.