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General NPI Number Information
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NPI Number | 1376524280
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Entity Type | Organization
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Legal Business Name | PANGUITCH DRUG CORP
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 95 E CENTER
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City | PANGUITCH
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State | UT
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Zip | 84759-0068
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Country | US
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Telephone | 435-676-2212
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Fax | 435-676-8850
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | PANGUITCH
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State | UT
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Zip | 84759-0068
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE MARSHALL
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Credential | RPH
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Telephone | 435-676-2212
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3417951703
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License Number State | UT
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