SOUTH STREET PHARMACY LLC NPI 1639482532

NPI Information

  • NPI: 1639482532
  • Provider Name: SOUTH STREET PHARMACY, LLC
  • Classification: Pharmacy - 333600000X
  • Entity Type: Organization
  • CLIA Number: 53D2169198
  • Address: 1456 SOUTH ST
    WHEATLAND, WY
    ZIP 82201
  • Phone: (307) 322-2486

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NPI Details

SOUTH STREET PHARMACY, LLC is a pharmacy in Wheatland, WY. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. SOUTH STREET PHARMACY, LLC NPI is 1639482532. The provider is registered as an organization entity type.

The provider's business location address is:

1456 SOUTH ST
WHEATLAND, WY
ZIP 82201-736
Phone: (307) 322-2486

The provider's authorized official is Corinda L Geile .
The authorized official title is President/owner and has the following contact phone number (307) 322-2486.

The CLIA number assigned to this NPI record is 53D2169198 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
  • Administration of pneumococcal vaccine (HCPCS:G0009)
  • Fee covid-19 vac 14 res (HCPCS:0134A)

The enumeration date for this NPI number is 7/20/2010 and was last updated on 8/21/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyR10063WYOMINGYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
16751900001MEDICARE NSCWYOMING
2129737600MEDICAIDWYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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