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Organization
PHARMACY AT PARK CITY CLINIC
Active
Organization
PHARMACY AT PARK CITY CLINIC
Active
Other names
Pharmacy at Park City Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KORTNEY STIRLAND RPH (RPH/OWNER)
(435) 644-2702
Entity
Organization
Contact information
Practice address
1665 BONANZA DR, PARK CITY, UT 84060-5127
(435) 776-9312
(435) 776-9317
Mailing address
1665 BONANZA DR, PARK CITY, UT 84060-5127
(435) 776-7525
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8088270-1703
UT
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4612102
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/22/2011
Last updated
02/17/2012
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