Provider Demographics
NPI:1730256157
Name:DEROMEDI, ANTHONY JOSEPH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:DEROMEDI
Suffix:
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 1:209 WEST MAIN
Mailing Address - Street 2:
Mailing Address - City:KIRBY
Mailing Address - State:WY
Mailing Address - Zip Code:82430
Mailing Address - Country:US
Mailing Address - Phone:307-760-5192
Mailing Address - Fax:307-864-9202
Practice Address - Street 1:621 RICHARDS ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-3041
Practice Address - Country:US
Practice Address - Phone:307-864-2369
Practice Address - Fax:307-864-9202
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist