Active NPI
Jeffrey Clark
- Pharmacy Technician
- Cheyenne, WY
National Provider Identifier
1477893477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 1633T
- Practice address
- 5353 Yellowstone Rd
Cheyenne, WY 82009-4178 - Phone
- (307) 532-6178
- NPI assigned
- Feb 27, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 1633T | WY | Primary |
Addresses
Primary practice location
5353 Yellowstone Rd
Cheyenne, WY 82009-4178
Mailing address
5712 Kennedy Dr
Cheyenne, WY 82001-7422
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 |
|---|---|---|---|
| 1633T | WY | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1477893477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5712 KENNEDY DR",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820017422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 YELLOWSTONE RD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820094178",
"telephone_number": "307-532-6178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JEFFREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-27",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "WY",
"license": "1633T",
"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 Feb 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.