Healthcare Provider Details

I. General information

NPI: 1942686761
Provider Name (Legal Business Name): STAPLEY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 E. MAIN STREET
ENTERPRISE UT
84725
US

IV. Provider business mailing address

167 E. MAIN STREET PO BOX 1057
ENTERPRISE UT
84725
US

V. Phone/Fax

Practice location:
  • Phone: 435-878-2300
  • Fax: 435-878-2303
Mailing address:
  • Phone: 435-878-2300
  • Fax: 435-878-2301

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 Number94842461703
License Number StateUT

VIII. Authorized Official

Name: CHRISTOPHER CHRISTENSEN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 435-673-3575