| NPI | 1356426753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID HOWARD BLACKHAM Pharmacy Director 435-462-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: UT 131751-1703) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: UT 131751-1703) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: UT 131751-1703) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: UT 131751-1703) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-11-12 |