Healthcare Provider Details

I. General information

NPI: 1982039590
Provider Name (Legal Business Name): G THRIFT CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAIN
GUNNISON UT
84634
US

IV. Provider business mailing address

PO BOX 395
GUNNISON UT
84634-0395
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-7555
  • Fax: 435-528-7553
Mailing address:
  • Phone: 435-528-3698
  • Fax: 435-528-7553

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 Number8733265-1703
License Number StateUT

VIII. Authorized Official

Name: SHAWN SORENSEN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 435-528-7555