Provider Demographics
NPI:1093576928
Name:ST GEORGE FAMILY PHARMACY
Entity Type:Organization
Organization Name:ST GEORGE FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-962-2557
Mailing Address - Street 1:736 S 900 E STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7001
Mailing Address - Country:US
Mailing Address - Phone:435-652-1548
Mailing Address - Fax:435-652-3059
Practice Address - Street 1:736 S 900 E STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7001
Practice Address - Country:US
Practice Address - Phone:435-652-1548
Practice Address - Fax:435-652-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy