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General NPI Number Information
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NPI Number | 1912403502
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Entity Type | Organization
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Legal Business Name | MARCHANTS PHARM WAGON
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 02/19/2022
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Provider Practice Location Address
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Address Line | 390 E MAIN ST
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City | SANTAQUIN
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State | UT
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Zip | 84655-7078
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Country | US
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Telephone | 801-754-1141
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Fax | 801-754-3141
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Provider Business Mailing Address
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Address Line | 390 E MAIN ST
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City | SANTAQUIN
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State | UT
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Zip | 84655-7078
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Country | US
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Telephone | 801-754-1141
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Fax | 801-754-3141
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. KEVIN SCOTT MARCHANT
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Credential | PHARM.D.
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Telephone | 435-691-4288
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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 | 10701041
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License Number State | UT
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