=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558391441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAPLEY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 12/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 E CITY CENTER ST
-----------------------------------------------------
City | SAINT GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84770-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-673-3575
-----------------------------------------------------
Fax | 435-673-2141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 E CITY CENTER ST
-----------------------------------------------------
City | SAINT GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84770-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-673-3575
-----------------------------------------------------
Fax | 435-673-2141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MANAGER
-----------------------------------------------------
Name | MR. CHRISTOPHER CHRISTENSEN
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 435-673-3575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5683021-1703
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------