Healthcare Provider Details

I. General information

NPI: 1528089570
Provider Name (Legal Business Name): SERVICE DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MAIN ST
DELTA UT
84624-9257
US

IV. Provider business mailing address

PO BOX 460
DELTA UT
84624-0460
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-2545
  • Fax: 435-864-5925
Mailing address:
  • Phone: 435-864-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3290331703
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROGER KILLPACK
Title or Position: OWNER
Credential: RPH
Phone: 435-864-2545