Healthcare Provider Details

I. General information

NPI: 1548364516
Provider Name (Legal Business Name): KAMAS FOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W 200 S
KAMAS UT
84036
US

IV. Provider business mailing address

PO BOX 560
KAMAS UT
84036-0560
US

V. Phone/Fax

Practice location:
  • Phone: 435-783-4316
  • Fax: 435-783-4370
Mailing address:
  • Phone: 435-783-4316
  • Fax: 435-783-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6206816-1703
License Number StateUT

VIII. Authorized Official

Name: DENIS TANNER
Title or Position: VP
Credential: RPH
Phone: 435-783-4369