Healthcare Provider Details

I. General information

NPI: 1326487182
Provider Name (Legal Business Name): SAMUEL I MARSHALL, P,C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 E CENTER
PANGUITCH UT
84759-0068
US

IV. Provider business mailing address

PO BOX 68
PANGUITCH UT
84759-0068
US

V. Phone/Fax

Practice location:
  • Phone: 435-676-2212
  • Fax: 435-676-8850
Mailing address:
  • Phone: 435-676-2212
  • Fax: 435-676-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8715464-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL IAN MARSHALL
Title or Position: OWNER
Credential: PHARMD
Phone: 435-590-8621