# GREEN RIVER MEDICAL CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREEN RIVER MEDICAL CENTER, INC.
- **Other names:** Green River Medical Center Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1689134868
- **Legal business name:** GREEN RIVER MEDICAL CENTER, INC.
- **Authorized official:** PAULA JEAN DUNHAM (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (435) 564-0213

## Contact information

- **Practice address:** 585 WEST MAIN STREET, GREEN RIVER, UT 84525
- **Practice address phone:** (435) 564-3434
- **Practice address fax:** (435) 564-3214
- **Mailing address:** PO BOX 417, GREEN RIVER, UT 84525-0417
- **Mailing address phone:** (435) 564-3434
- **Mailing address fax:** (435) 564-3214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/22/2019
- **Last updated:** 03/07/2023

## 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 |