| NPI | 1538284716 |
|---|---|
| Doing Business As | 12TH STREET PHARMACY |
| Entity Type | Organization |
| Authorized Contact | WALLACE EGGLESTON Owner And Pharmacist 801-621-2154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: UT 362500-1703) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-09-23 |