# GREEN RIVER MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carbon Medical Pharmacy Green River
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841540077
- **Authorized official:** RUSSELL SCOW (PHARMACY DIRECTOR)
- **Authorized official phone:** (435) 888-0422

## Contact information

- **Practice address:** 585 WEST MAIN STREET, GREEN RIVER, UT 84525
- **Practice address phone:** (435) 888-0422
- **Practice address fax:** (435) 888-0860
- **Mailing address:** PO BOX 417, GREEN RIVER, UT 84525-0417
- **Mailing address phone:** (435) 564-3434
- **Mailing address fax:** (435) 564-9214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 3739881704 | UT | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/14/2012
- **Last updated:** 10/06/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2137052 | PK | — |