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General NPI Number Information
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NPI Number | 1790500171
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Entity Type | Organization
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Legal Business Name | BEAR LAKE DRUG GARDEN CITY
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 288 S PARADISE PARKWAY PHARMACY
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City | GARDEN CITY
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State | UT
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Zip | 84028
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Country | US
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Telephone | 435-294-2300
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Fax | 435-990-7240
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Provider Business Mailing Address
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Address Line | 836 WASHINGTON ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1423
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Country | US
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Telephone | 435-294-2300
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Fax |
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Authorized Official
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Title or Position | OWNER, PHARMACIST IN CHARGE
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Name | CASEY HUMPHERYS
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Credential | PHARMD
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Telephone | 208-589-9657
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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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