Healthcare Provider Details

I. General information

NPI: 1114024957
Provider Name (Legal Business Name): PHIL RICH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 N 400 E E2
NORTH LOGAN UT
84341-1749
US

IV. Provider business mailing address

2380 N 400 E E2
NORTH LOGAN UT
84341-1749
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-1212
  • Fax: 435-787-1922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number61935351704
License Number StateUT

VIII. Authorized Official

Name: PHILLIP COWLEY
Title or Position: OWNER
Credential: RPH
Phone: 435-787-1212