Healthcare Provider Details

I. General information

NPI: 1689686636
Provider Name (Legal Business Name): BHB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 S MAIN ST
EPHRAIM UT
84627-4017
US

IV. Provider business mailing address

475 S MAIN ST
EPHRAIM UT
84627-4017
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-0340
  • Fax: 435-283-0341
Mailing address:
  • Phone: 435-283-0340
  • Fax: 435-283-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number276768-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number276768-1703
License Number StateUT

VIII. Authorized Official

Name: JAMES FULLMER
Title or Position: REGISTERED PHARMACIST
Credential: REGISTERED PHARMACIS
Phone: 435-283-0340