Provider Demographics
NPI:1114024957
Name:PHIL RICH INC
Entity Type:Organization
Organization Name:PHIL RICH INC
Other - Org Name:LTC OF CACHE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-787-1212
Mailing Address - Street 1:2380 N 400 E
Mailing Address - Street 2:E2
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:E2
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1749
Practice Address - Country:US
Practice Address - Phone:435-787-1212
Practice Address - Fax:435-787-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT619353517043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4610627OtherOTHER ID NUMBER-COMMERCIAL NUMBER
UT61935351704Medicaid