Basic Information
| Provider Information | |||||||||
| NPI: | 1053059865 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTHCARE PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2276 E RIVERSIDE DR. | ||||||||
| Address2: | |||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359862565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2276 E RIVERSIDE DR. | ||||||||
| Address2: | |||||||||
| City: | ST. GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359862565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2022 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST IN CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 4359862565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
| NPICertificationDate: | 05/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | Y | Suppliers | Pharmacy |
No ID Information.