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General NPI Number Information
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NPI Number | 1376264432
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Entity Type | Organization
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Legal Business Name | KTM PHARMACY
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 1483 E 3850 S UNIT B
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City | ST GEORGE
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State | UT
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Zip | 84790-6233
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Country | US
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Telephone | 435-628-0842
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Fax | 435-628-0682
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Provider Business Mailing Address
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Address Line | 2564 E MOUNTAIN LEDGE CIR
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City | ST GEORGE
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State | UT
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Zip | 84790-5052
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Country | US
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Telephone | 435-817-5559
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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 | KENNY JONES
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Credential | PHARMD
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Telephone | 435-817-5559
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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 |
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License Number State |
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