Provider Demographics
NPI:1285663021
Name:PHILRICH INC
Entity Type:Organization
Organization Name:PHILRICH INC
Other - Org Name:CACHE VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-787-1212
Mailing Address - Street 1:2245 N 400 E STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1785
Mailing Address - Country:US
Mailing Address - Phone:435-787-1212
Mailing Address - Fax:435-787-1922
Practice Address - Street 1:2245 N 400 E STE 105
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1785
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:2006-07-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5092448-17033336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========004Medicaid
UT4553630001Medicare NSC