Basic Information
| Provider Information | |||||||||
| NPI: | 1780950253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICATION MANAGEMENT SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2476 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820032476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076380300 | ||||||||
| FaxNumber: | 3076380394 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 E LINCOLNWAY | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820014703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077787550 | ||||||||
| FaxNumber: | 3074323801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 07/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | FUCHS | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3076380300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 18740.1004 | WY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.