Healthcare Provider Details

I. General information

NPI: 1083359988
Provider Name (Legal Business Name): HIGH CREEK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S HIGHWAY 91
RICHMOND UT
84333-1208
US

IV. Provider business mailing address

135 N 3RD E
PRESTON ID
83263-1122
US

V. Phone/Fax

Practice location:
  • Phone: 435-258-5560
  • Fax: 435-258-5538
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT MORRELL
Title or Position: PIC AND OWNER
Credential: PHARMD
Phone: 435-258-5560