Organization
DIVERSIFIED PROFESSIONAL COMPANY
Active
Other names
Peterson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY LYNN BAILEY RPH (PRESIDENT)
(801) 479-4030
Entity
Organization
Contact information
Practice address
4650 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 479-4030
(801) 475-7051
Mailing address
PO BOX 150010, OGDEN, UT 84415-0010
(801) 479-4030
(801) 475-7051
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
132801-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870218488006
—
UT
Enumeration date
10/20/2006
Last updated
02/19/2008
Update your record
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