Healthcare Provider Details

I. General information

NPI: 1245536051
Provider Name (Legal Business Name): SBB PHARMACEUTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E MAIN ST
GRANTSVILLE UT
84029-9029
US

IV. Provider business mailing address

4776 AUTUMN CV
ERDA UT
84074-5548
US

V. Phone/Fax

Practice location:
  • Phone: 435-884-9990
  • Fax: 435-884-6997
Mailing address:
  • Phone: 435-884-9990
  • Fax: 435-884-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7907135-1703
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHELDON BIRCH
Title or Position: OWNER
Credential:
Phone: 435-882-7775