Organization
HI MOUNTAIN DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CRAIG C VAN TASSELL RPH (OWNER PHARMACIST)
(435) 783-4466
Entity
Organization
Contact information
Practice address
40 NORTH MAIN, KAMAS, UT 84036
(435) 783-4466
(435) 783-4567
Mailing address
PO BOX 67, KAMAS, UT 84036
(435) 783-4466
(435) 783-4567
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0285417220
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870277118002
—
UT
Enumeration date
02/21/2007
Last updated
06/18/2008
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