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Organization
12TH ST PHARMACY INC
Active
Organization
12TH ST PHARMACY INC
Active
Other names
12TH STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE EGGLESTON (OWNER AND PHARMACIST)
(801) 621-2154
Entity
Organization
Contact information
Practice address
698 12TH ST, OGDEN, UT 84404-6200
(801) 621-2154
(801) 627-9523
Mailing address
698 12TH ST, OGDEN, UT 84404-6200
(801) 621-2154
(801) 627-9523
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
362500-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2100182
PK
—
Enumeration date
03/20/2007
Last updated
09/23/2016
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