# DIVERSIFIED PROFESSIONAL COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peterson Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396827077
- **Authorized official:** MR. GARY LYNN BAILEY RPH (PRESIDENT)
- **Authorized official phone:** (801) 479-4030

## Contact information

- **Practice address:** 4650 HARRISON BLVD, OGDEN, UT 84403-4303
- **Practice address phone:** (801) 479-4030
- **Practice address fax:** (801) 475-7051
- **Mailing address:** PO BOX 150010, OGDEN, UT 84415-0010
- **Mailing address phone:** (801) 479-4030
- **Mailing address fax:** (801) 475-7051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 132801-1703 | UT | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 02/19/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 870218488006 | — | UT |