Healthcare Provider Details

I. General information

NPI: 1164780854
Provider Name (Legal Business Name): SANTAQUIN PHARMACY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 E MAIN ST
SANTAQUIN UT
84655-7078
US

IV. Provider business mailing address

390 E MAIN ST
SANTAQUIN UT
84655-7078
US

V. Phone/Fax

Practice location:
  • Phone: 801-754-1141
  • Fax: 801-754-3141
Mailing address:
  • Phone: 801-754-1141
  • Fax: 801-754-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7373707-1703
License Number StateUT

VIII. Authorized Official

Name: MR. JIM WEBSTER
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 801-754-1141