Healthcare Provider Details

I. General information

NPI: 1497170401
Provider Name (Legal Business Name): HOBBLE CREEK FAMILY PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 W CENTER ST
PROVO UT
84601-4419
US

IV. Provider business mailing address

286 W CENTER ST
PROVO UT
84601-4419
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-7288
  • Fax: 801-373-0673
Mailing address:
  • Phone: 801-373-7288
  • Fax: 801-373-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8890134-1703
License Number StateUT

VIII. Authorized Official

Name: KENT TAYLOR
Title or Position: PHARMACIST
Credential:
Phone: 801-373-7288