Organization
MT NEBO THRIFT CORP
Active
Other names
MT NEBO PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD MEASOM (RX SUPERVISOR)
(801) 465-2347
Entity
Organization
Contact information
Practice address
965 N MAIN ST, NEPHI, UT 84648
(435) 623-2183
(435) 623-4237
Mailing address
965 N MAIN ST, NEPHI, UT 84648-1003
(435) 623-2183
(435) 623-4237
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8963467-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649697244
—
UT
01
—
2145208
PK
—
Enumeration date
03/21/2014
Last updated
06/18/2018
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