Healthcare Provider Details

I. General information

NPI: 1386689420
Provider Name (Legal Business Name): WILLIAMS FAMILY DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W MAIN ST
GRANTSVILLE UT
84029-9621
US

IV. Provider business mailing address

124 W MAIN ST
GRANTSVILLE UT
84029-9621
US

V. Phone/Fax

Practice location:
  • Phone: 435-884-3285
  • Fax: 435-884-6873
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number61246091703
License Number StateUT

VIII. Authorized Official

Name: SCOTT WILLIAMS
Title or Position: OWNER
Credential: RPH
Phone: 435-884-3285