Organization
GREEN RIVER MEDICAL CENTER INC
Active
Other names
Carbon Medical Pharmacy Green River
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL SCOW (PHARMACY DIRECTOR)
(435) 888-0422
Entity
Organization
Contact information
Practice address
585 WEST MAIN STREET, GREEN RIVER, UT 84525
(435) 888-0422
(435) 888-0860
Mailing address
PO BOX 417, GREEN RIVER, UT 84525-0417
(435) 564-3434
(435) 564-9214
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
3739881704
UT
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137052
PK
—
Enumeration date
09/14/2012
Last updated
10/06/2015
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