Provider Demographics
NPI:1902990633
Name:WRIVS INC
Entity Type:Organization
Organization Name:WRIVS INC
Other - Org Name:QUALITY I.V. CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:WALDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:307-742-5048
Mailing Address - Street 1:3131 E GRAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5140
Mailing Address - Country:US
Mailing Address - Phone:307-742-5048
Mailing Address - Fax:307-745-0432
Practice Address - Street 1:3131 E GRAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5140
Practice Address - Country:US
Practice Address - Phone:307-742-5048
Practice Address - Fax:307-745-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2366183500000X
WY52-02394332B00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5202394Medicaid
WY107021501Medicaid
WY107021501Medicaid