1447323357 NPI number — LSJ FAMILY DRUG DBA LSJ UNITED DRUG

Table of content: (NPI 1447323357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447323357 NPI number — LSJ FAMILY DRUG DBA LSJ UNITED DRUG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LSJ FAMILY DRUG DBA LSJ UNITED DRUG
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:
1447323357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841429
Provider Second Line Business Mailing Address:
1280 WEST UTAH AVENUE
Provider Business Mailing Address City Name:
HILDALE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84784-1429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-874-1415
Provider Business Mailing Address Fax Number:
435-874-1417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 WEST UTAH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILDALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84784-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-874-1415
Provider Business Practice Location Address Fax Number:
435-874-1417
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-874-1415

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  1319181701 , 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)

  • Identifier: 4610196 . This is a "NCPDP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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