# BEAR LAKE DRUG GARDEN CITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bear Lake Drug Garden City
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790500171
- **Authorized official:** CASEY HUMPHERYS PHARMD (OWNER, PHARMACIST IN CHARGE)
- **Authorized official phone:** (208) 589-9657

## Contact information

- **Practice address:** 288 S PARADISE PARKWAY, PHARMACY, GARDEN CITY, UT 84028
- **Practice address phone:** (435) 294-2300
- **Practice address fax:** (435) 990-7240
- **Mailing address:** 836 WASHINGTON ST, MONTPELIER, ID 83254-1423
- **Mailing address phone:** (435) 294-2300

## Taxonomy

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

## Other

- **Enumeration date:** 11/20/2024
- **Last updated:** 04/11/2025