=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003030602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN VIEW HOSPITAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 E 100 N
-----------------------------------------------------
City | PAYSON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-465-7097
-----------------------------------------------------
Fax | 801-465-7410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 E 100 N
-----------------------------------------------------
City | PAYSON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-465-7097
-----------------------------------------------------
Fax | 801-465-7410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MARK L JOHNSON
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 801-465-7097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 1252721704
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------