Enevoldsen, Jade

Enevoldsen, Jade is an individual health care provider with primary practice located at 4308 E Grand Ave , Laramie WY 82070-5508. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Enevoldsen, Jade can be contacted via phone (307) 745-6112.

Contact Information

Primary practice address
4308 E Grand Ave Laramie WY 82070-5508
Phone: (307) 745-6112
Fax: (307) 721-4975
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 3784 Wyoming

Profile Details

NPI number 1669877015
LBN Legal business name Enevoldsen, Jade
Credentials PHARM. D.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 28th, 2014
Last updated Oct 28th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669877015 NPPES
Wyoming Other 3784 PHARMACIST LICENSE

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