Organization
MOUNTAINLANDS FAMILY PHARMACY
Active
Other names
Mountainlands Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TODD BAILEY (CEO)
(801) 429-2011
Entity
Organization
Contact information
Practice address
589 S STATE ST, PROVO, UT 84606-5056
(801) 429-2000
Mailing address
589 S STATE ST, PROVO, UT 84606-5056
(801) 429-2000
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0003X
Community/Retail Pharmacy
7630544-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4611821
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/24/2010
Last updated
03/27/2025
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