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General NPI Number Information
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NPI Number | 1063400448
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Entity Type | Organization
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Legal Business Name | TREMONTON COMMUNITY PHARMACY INC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 44 E MAIN ST
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City | TREMONTON
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State | UT
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Zip | 84337-1624
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Country | US
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Telephone | 435-257-5249
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Fax | 435-257-5481
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Provider Business Mailing Address
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Address Line | 44 E MAIN ST
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City | TREMONTON
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State | UT
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Zip | 84337-1624
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Country | US
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Telephone | 435-257-5249
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Fax | 435-257-5481
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MR. LARRY BRENT DURRANT
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Credential | RPH
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Telephone | 435-757-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2755121703
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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