Scotch Pine Pharmacy

LBN: Wade R Poulson
Scotch Pine Pharmacy is an health care organization with primary practice located at 1322 N Scotch Pine Dr , Duchesne UT 84021-0464. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Wade R Poulson can be contacted via phone (435) 738-0155, or through Poulson, Wade via phone (801) 389-0267.

Contact Information

Primary practice address
1322 N Scotch Pine Dr Duchesne UT 84021-0464
Phone: (435) 738-0155
Fax: (435) 738-0153
Website:
Map and Directions
Authorized official contact:
Name: Poulson, Wade
Phone: (801) 389-0267

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1154640555
LBN Legal business name Wade R Poulson
DBA Doing business as Scotch Pine Pharmacy
Authorized official Poulson, Wade
Entity Organization
Organization subpart 1 No
Enumeration date May 25th, 2010
Last updated Nov 12th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154640555 NPPES
Other 4611833 NCPDP PROVIDER IDENTIFICATION NUMBER

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