MEDICARE: C AND C PHARMACIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	272660	UT

General Provider Information

NPI Number	:	1114083359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C AND C PHARMACIES INC

Provider Business Mailing Address
First Line	:	1017 MEDICAL DR
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3049
Country	:	US
Telephone Number	:	435-723-5211
Fax Number	:	435-723-6379

Provider Business Practice Location Address
First Line	:	1017 MEDICAL DR
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3049
Country	:	US
Telephone Number	:	435-723-5211
Fax Number	:	435-723-6379

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. MICHAEL CONGER
Credential	:	RPH
Telephone Number	:	435-723-5211

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	12/29/2021

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