Organization
PHARMACY AT PARK CITY CLINIC
Active
Other names
Pharmacy at Park City Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KORTNEY STIRLAND RPH (RPH/OWNER)
(435) 644-2702
Entity
Organization
Contact information
Practice address
1665 BONANZA DR, PARK CITY, UT 84060-5127
(435) 776-9312
(435) 776-9317
Mailing address
1665 BONANZA DR, PARK CITY, UT 84060-5127
(435) 776-7525
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8088270-1703
UT
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4612102
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/22/2011
Last updated
02/17/2012
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