Healthcare Provider Details

I. General information

NPI: 1881677722
Provider Name (Legal Business Name): BEAVER VALLEY PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 N MAIN ST
BEAVER UT
84713-1438
US

IV. Provider business mailing address

PO BOX 1438 98 N MAIN ST
BEAVER UT
84713-1438
US

V. Phone/Fax

Practice location:
  • Phone: 435-438-2588
  • Fax:
Mailing address:
  • Phone: 435-438-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BYRON SCOTT ROBINSON
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 435-438-2588