Provider Demographics
NPI:1053059865
Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Other - Org Name:FAMILY HEALTHCARE PHARMACY 340B
Other - Org Type:Other Name
Authorized Official - Title/Position:340B MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVKIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-359-9899
Mailing Address - Street 1:2276 E RIVERSIDE DR.
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-359-9899
Mailing Address - Fax:
Practice Address - Street 1:2276 E RIVERSIDE DR.
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-986-2565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-23
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy