Provider Demographics
NPI:1093875387
Name:NEPHI PROFESSIONAL PHARMACY
Entity Type:Organization
Organization Name:NEPHI PROFESSIONAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:N
Authorized Official - Last Name:OLPIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-623-2183
Mailing Address - Street 1:965 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-1003
Mailing Address - Country:US
Mailing Address - Phone:435-623-2183
Mailing Address - Fax:435-623-4237
Practice Address - Street 1:965 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1003
Practice Address - Country:US
Practice Address - Phone:435-623-2183
Practice Address - Fax:435-623-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131246-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4606755OtherNCPDP #
UT131246-1703OtherUTAH PHARMACY LICENCE #
UTBN1531640OtherDEA REGISTRATION #
UT=========008Medicaid
UT0930530001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #