NPI Code Detail JSON Logo

1811708308 NPI number — CACHE VALLEY PHARMACARE LLC

NPI Number: 1811708308
Health Care Provider/Practitioner: CACHE VALLEY PHARMACARE LLC

Information about “1811708308” NPI (CACHE VALLEY PHARMACARE LLC) exists in 1811708308 in HTML format HTML  |  1811708308 in plain Text format TXT  |  1811708308 in PDF (Portable Document Format) PDF  |  1811708308 in an XML format XML  formats.

NPI Number : 1811708308 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811708308",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CACHE VALLEY PHARMACARE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1438",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEAVER",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84713-1438",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2245 N 400 E STE 105",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTH LOGAN",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84341-1785",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "435-757-1212",
    "PracticeLocationAddressFaxNumber": "435-787-1922",
    "EnumerationDate": "01/15/2025",
    "LastUpdateDate": "01/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ROBINSON",
    "AuthorizedOfficialFirstName": "BYRON",
    "AuthorizedOfficialMiddleName": "SCOTT",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RPH",
    "AuthorizedOfficialTelephoneNumber": "435-421-1685",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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