# SKYLINE PHARMACY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356426753
- **Authorized official:** MR. DAVID HOWARD BLACKHAM RPH (PHARMACY DIRECTOR)
- **Authorized official phone:** (435) 462-2434

## Contact information

- **Practice address:** 1 W MAIN ST, MT PLEASANT, UT 84647-1327
- **Practice address phone:** (435) 462-2434
- **Practice address fax:** (435) 462-3400
- **Mailing address:** 1 W MAIN ST, MT PLEASANT, UT 84647-1327
- **Mailing address phone:** (435) 462-2434
- **Mailing address fax:** (435) 462-3400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | 131751-1703 | UT | — |
| 3336C0003X | Community/Retail Pharmacy | 131751-1703 | UT | Yes |
| 3336C0004X | Compounding Pharmacy | 131751-1703 | UT | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | 131751-1703 | UT | — |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 11/12/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4606301 | NABP\# | UT |
| 05 | — | 840437031001 | — | UT |