Healthcare Provider Details

I. General information

NPI: 1518075191
Provider Name (Legal Business Name): DELTA DRUG & GIFT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MAIN ST
DELTA UT
84624-8497
US

IV. Provider business mailing address

PO BOX 220
DELTA UT
84624-0220
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-5122
  • Fax: 435-864-2706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1319331703
License Number StateUT

VIII. Authorized Official

Name: JAMES PIERSON
Title or Position: MGR
Credential:
Phone: 435-864-5122