NPIMap

Organization Active NPI

Osback Pharmaceuticals Inc

  • Community/Retail Pharmacy
  • Lander, WY
National Provider Identifier
1851462295
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
R10054 Issued in WY
Legal business name
OSBACK PHARMACEUTICALS INC
Practice address
634 Main St
Lander, WY 82520-3034
Phone
(307) 332-2270
Fax
(307) 332-6007
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jolene Osback, PHARMD
Title
Owner
Phone
(307) 332-2270

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X R10054 WY Primary

Addresses

Primary practice location

634 Main St
Lander, WY 82520-3034

Mailing address

634 Main St
Lander, WY 82520-3034
Phone (307) 332-2270

Other identifiers 2

IdentifierTypeStateIssuer
103910501MedicaidWY
2120702OtherPK

Other names 1

  • Palace Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161027000586 WY Part B Supplier - Mass Immunization (Roster Biller Only) 5193003051 Practice locations: Lander, WY

National Provider Directory

National Provider Directory

Locations

634 Main St
Lander, WY 82520
Phone (307) 332-2715

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1851462295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 MAIN ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203034",
            "telephone_number": "307-332-2270",
            "fax_number": "307-332-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 MAIN ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203034",
            "telephone_number": "307-332-2270",
            "fax_number": "307-332-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSBACK PHARMACEUTICALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2016-08-30",
        "status": "A",
        "authorized_official_last_name": "OSBACK",
        "authorized_official_first_name": "JOLENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-332-2270",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WY",
            "license": "R10054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103910501",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120702",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palace Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lander, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.