Organization
DIVERSIFIED PROFESSIONAL COMPANY
Active
Other names
Canyon View Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY LYNN BAILEY RPH (PRESIDENT)
(801) 334-3190
Entity
Organization
Contact information
Practice address
1159 E 12TH STREET, OGDEN, UT 84404-5144
(801) 334-3190
(801) 334-3193
Mailing address
1159 E 12TH STREET, OGDEN, UT 84404-5144
(801) 334-3190
(801) 334-3193
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870218488006
—
UT
Enumeration date
10/20/2006
Last updated
08/22/2020
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