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General NPI Number Information
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NPI Number | 1154411601
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Entity Type | Organization
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Legal Business Name | ABC ENTERPRISES I, LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1050 SOUTH MEDICAL DRIVE SUITE B
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City | MT. PLEASANT
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State | UT
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Zip | 84647
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Country | US
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Telephone | 435-462-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 SOUTH MEDICAL DRIVE SUITE B
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City | MT. PLEASANT
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State | UT
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Zip | 84647
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Country | US
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Telephone | 435-462-0116
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DR. BRENT W PETERSON
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Credential | PHARM.D.
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Telephone | 435-851-1510
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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 |
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License Number State |
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