Organization
SKYLINE PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID HOWARD BLACKHAM RPH (PHARMACY DIRECTOR)
(435) 462-2434
Entity
Organization
Contact information
Practice address
1 W MAIN ST, MT PLEASANT, UT 84647-1327
(435) 462-2434
(435) 462-3400
Mailing address
1 W MAIN ST, MT PLEASANT, UT 84647-1327
(435) 462-2434
(435) 462-3400
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
131751-1703
UT
3336C0003X
Community/Retail Pharmacy
Primary
131751-1703
UT
3336C0004X
Compounding Pharmacy
131751-1703
UT
3336H0001X
Home Infusion Therapy Pharmacy
131751-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4606301
NABP#
UT
05
—
840437031001
—
UT
Enumeration date
10/25/2006
Last updated
11/12/2007
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