Healthcare Provider Details

I. General information

NPI: 1063834760
Provider Name (Legal Business Name): GUNNISON FAMILY PHARMACY & FLORAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SOUTH MAIN STREET
GUNNINSON UT
84634
US

IV. Provider business mailing address

PO BOX 789
GUNNISON UT
84634-0789
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-3455
  • Fax: 435-528-3776
Mailing address:
  • Phone: 435-528-3455
  • Fax: 435-528-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8357604-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY ADAM HARDY
Title or Position: PIC
Credential: PHARMD
Phone: 435-528-3455