Organization
CANYON PHARMACEUTICAL, LLC
Active
Other names
Rock Canyon Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN JOHANSEN (OWNER)
(801) 440-2995
Entity
Organization
Contact information
Practice address
3179 N CANYON RD, PROVO, UT 84604-3916
(801) 377-2002
(801) 377-2007
Mailing address
3179 N CANYON RD, PROVO, UT 84604-3916
(801) 377-2002
(801) 377-2007
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
50843661703
UT
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710871500008
—
UT
Enumeration date
06/11/2006
Last updated
08/15/2022
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