Provider Demographics
NPI:1942931449
Name:GORE, LYNDIE N (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LYNDIE
Middle Name:N
Last Name:GORE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LYNDIE
Other - Middle Name:N
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:457 S WHEATLAND HWY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-8520
Mailing Address - Country:US
Mailing Address - Phone:303-396-9109
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY39771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3977OtherWYOMING BOARD OF PHARMACY