# PROFESSIONAL PARK PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROFESSIONAL PARK, PROFESSIONAL PARK PHARMACY INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891770715
- **Authorized official:** R BRAD ANDERSON (PRESIDENT)
- **Authorized official phone:** (435) 652-1548

## Contact information

- **Practice address:** 736 S 900 E STE 102, ST GEORGE, UT 84790-7001
- **Practice address phone:** (435) 652-1548
- **Practice address fax:** (435) 652-3059
- **Mailing address:** 736 S 900 E STE 102, ST GEORGE, UT 84790-7001
- **Mailing address phone:** (435) 652-1548
- **Mailing address fax:** (435) 652-3059

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 3506771703 | UT | Yes |

## Other

- **Enumeration date:** 12/13/2005
- **Last updated:** 11/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2100294 | PK | — |