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General NPI Number Information
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NPI Number | 1083948210
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Entity Type | Organization
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Legal Business Name | PARK CITY MARKET INC
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 1500 SNOW CREEK DR
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City | PARK CITY
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State | UT
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Zip | 84060-7506
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Country | US
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Telephone | 435-645-7916
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Fax | 435-655-7019
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Provider Business Mailing Address
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Address Line | PO BOX 26417
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City | SALT LAKE CITY
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State | UT
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Zip | 84126-0417
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Country | US
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Telephone | 801-978-8225
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Fax | 801-978-8634
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL HOLM
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Credential | RPH, MBA
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Telephone | 435-645-7139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 6957464-1703
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License Number State | UT
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