Organization
SAN JUAN PHARMACY MONTICELLO INC.
Active
Other names
MAIN STREET DRUG & BOUTIQUE
Organization subpart
No
Provider details
NPI number
Authorized official
TIM YOUNG (OWNER)
(435) 587-2302
Entity
Organization
Contact information
Practice address
140 S MAIN ST, MONTICELLO, UT 84535
(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
127088-1703
UT
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107592
PK
—
05
—
876000616040
—
UT
05
—
88084876
—
CO
Enumeration date
05/17/2007
Last updated
04/13/2022
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