1245536051 NPI number — SBB PHARMACEUTICAL LLC

Table of content: (NPI 1245536051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245536051 NPI number — SBB PHARMACEUTICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SBB PHARMACEUTICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIRCH FAMILY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245536051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4776 AUTUMN CV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERDA
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84074-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-884-9990
Provider Business Mailing Address Fax Number:
435-884-6997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84029-9029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-884-9990
Provider Business Practice Location Address Fax Number:
435-884-6997
Provider Enumeration Date:
01/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIRCH
Authorized Official First Name:
SHELDON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-882-7775

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  7907135-1703 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1245536051 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2128428 . This is a "PK" identifier . This identifiers is of the category "OTHER".