Provider Demographics
NPI:1114565280
Name:THE VILLAGE PANTRY #9
Entity Type:Organization
Organization Name:THE VILLAGE PANTRY #9
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETTYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-489-5618
Mailing Address - Street 1:405 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2252
Mailing Address - Country:US
Mailing Address - Phone:801-489-5618
Mailing Address - Fax:804-489-0441
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2252
Practice Address - Country:US
Practice Address - Phone:801-489-5618
Practice Address - Fax:801-489-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy