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Organization
DIVERSIFIED PROFESSIONAL COMPANY
Active
Organization
DIVERSIFIED PROFESSIONAL COMPANY
Active
Other names
Canyon View Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY LYNN BAILEY RPH (PRESIDENT)
(801) 334-3190
Entity
Organization
Contact information
Practice address
1159 E 12TH STREET, OGDEN, UT 84404-5144
(801) 334-3190
(801) 334-3193
Mailing address
1159 E 12TH STREET, OGDEN, UT 84404-5144
(801) 334-3190
(801) 334-3193
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870218488006
—
UT
Enumeration date
10/20/2006
Last updated
08/22/2020
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