Healthcare Provider Details

I. General information

NPI: 1023637675
Provider Name (Legal Business Name): SANTAQUIN MARKET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N. 400 E.
SANTAQUIN UT
84655
US

IV. Provider business mailing address

586 N MAIN ST
PAYSON UT
84651-3428
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2343
  • Fax:
Mailing address:
  • Phone: 801-465-2343
  • Fax: 801-465-0856

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: HAROLD MEASOM
Title or Position: MANAGER
Credential: PHARM.D.
Phone: 801-465-2343