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Contact Information

SAN JUAN PHARMACY MONTICELLO INC.
140 S MAIN ST
MONTICELLO, UT84535
 Phone: 435-587-2302
 Fax: 435-587-3441
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SAN JUAN PHARMACY MONTICELLO INC.

NPI Number 1215144308
LBN Legal business name SAN JUAN PHARMACY MONTICELLO INC.
Authorized official TIM YOUNG - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/17/2007
Last updated 04/13/2022 - About 4 years ago
Identifiers
UT License # 127088-1703
CO Medicaid 88084876
UT Medicaid 876000616040
Other 2107592 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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