Provider Demographics
NPI:1316187602
Name:HURRICANE FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:HURRICANE FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-962-2557
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-0249
Mailing Address - Country:US
Mailing Address - Phone:435-635-8200
Mailing Address - Fax:
Practice Address - Street 1:25 N 2000 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-4111
Practice Address - Country:US
Practice Address - Phone:435-635-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HURRICANE FAMILY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-25
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6120590001Medicare NSC