Provider Demographics
NPI:1225265689
Name:KTM HEALTH CARE INC
Entity Type:Organization
Organization Name:KTM HEALTH CARE INC
Other - Org Name:ENTERPRISE VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:KATSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-592-1056
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-0761
Mailing Address - Country:US
Mailing Address - Phone:775-726-3771
Mailing Address - Fax:775-726-3685
Practice Address - Street 1:660 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-878-2760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7359434-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7359434-1703OtherSTATE BOARD OF PHARMACY LICENSE NUMBER