Provider Demographics
NPI:1083716310
Name:DICKS FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:DICKS FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LOVERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-2222
Mailing Address - Street 1:2280 SO ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5614
Mailing Address - Country:US
Mailing Address - Phone:801-296-2222
Mailing Address - Fax:801-296-2238
Practice Address - Street 1:2280 SO ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5614
Practice Address - Country:US
Practice Address - Phone:801-296-2222
Practice Address - Fax:801-296-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT330257-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid