# BASIN FAMILY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BASIN FAMILY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316042179
- **Authorized official:** JEFFREY LUKE RPH (OWNER)
- **Authorized official phone:** (435) 722-2454

## Contact information

- **Practice address:** 245 W HIGHWAY 40, ROOSEVELT, UT 84066-3712
- **Practice address phone:** (435) 722-2454
- **Practice address fax:** (435) 722-4191
- **Mailing address:** 245 W HIGHWAY 40, ROOSEVELT, UT 84066-3712
- **Mailing address phone:** (435) 722-2454
- **Mailing address fax:** (435) 722-4191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 4905987-1703 | UT | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 09/10/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2106870 | PK | — |