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Organization
GREEN RIVER MEDICAL CENTER, INC.
Active
Organization
GREEN RIVER MEDICAL CENTER, INC.
Active
Parent organization
GREEN RIVER MEDICAL CENTER, INC.
Other names
Green River Medical Center Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREEN RIVER MEDICAL CENTER, INC.
Authorized official
PAULA JEAN DUNHAM (EXECUTIVE DIRECTOR)
(435) 564-0213
Entity
Organization
Contact information
Practice address
585 WEST MAIN STREET, GREEN RIVER, UT 84525
(435) 564-3434
(435) 564-3214
Mailing address
PO BOX 417, GREEN RIVER, UT 84525-0417
(435) 564-3434
(435) 564-3214
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11065988-1703
UTAH DOPL PHARMACY CLASS A LICENSE
UT
01
—
11065988-8913
UTAH DOPL DISPENSING CONTROLLED SUBSTANCE LICENSE
UT
05
—
261QF0400X
—
UT
Enumeration date
03/22/2019
Last updated
03/07/2023
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