Healthcare Provider Details

I. General information

NPI: 1881292167
Provider Name (Legal Business Name): 3BC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 NORTH GATEWAY DRIVE #802
PROVIDENCE UT
84332
US

IV. Provider business mailing address

716 E 350 S
LOGAN UT
84321-5683
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-2665
  • Fax:
Mailing address:
  • Phone: 435-770-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT COOK
Title or Position: OWNER
Credential: PHARMD
Phone: 435-770-2665