Organization
MAIN STREET DRUG & BOUTIQUE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER GILSON PHARMD (PRESIDENT/PHARMACIST)
(435) 650-2736
Entity
Organization
Contact information
Practice address
140 S MAIN ST, MONTICELLO, UT 84535-7728
(435) 587-2302
(435) 587-3441
Mailing address
PO BOX 519, MONTICELLO, UT 84535-0519
(435) 587-2302
(435) 587-3441
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Enumeration date
12/09/2021
Last updated
12/09/2021
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