| NPI | 1033630918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY KIM HANSEN Owner/Pharmacist In Charge 435-674-0201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5725931-1701) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-07-21 |