1184134819 NPI number — PHARMBOY VENTURES UNLIMITED INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184134819 NPI number — PHARMBOY VENTURES UNLIMITED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMBOY VENTURES UNLIMITED INC
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:
Provider Other Organization Name Type Code:
6
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:
1184134819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2376 RED CLIFFS DR STE 377
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84790-8367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2376 E RED CLIFFS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 377
Provider Business Practice Location Address City Name:
ST. GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-255-7160
Provider Business Practice Location Address Fax Number:
435-255-7202
Provider Enumeration Date:
10/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MCFADDEN
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
435-255-7160

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  10527986-1703 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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