Healthcare Provider Details

I. General information

NPI: 1952657934
Provider Name (Legal Business Name): TIBBITTS FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N CHURCH ST STE 201
LAYTON UT
84040-6503
US

IV. Provider business mailing address

2940 N CHURCH ST STE 201
LAYTON UT
84040-6503
US

V. Phone/Fax

Practice location:
  • Phone: 801-771-0363
  • Fax: 801-771-0506
Mailing address:
  • Phone: 801-771-0363
  • Fax: 801-771-0506

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 Number8393226-1703
License Number StateUT

VIII. Authorized Official

Name: BRETT TIBBITTS
Title or Position: OWNER/PHARMACIST-IN-CHARGE
Credential:
Phone: 801-771-0363