Provider Demographics
NPI:1326218694
Name:DRY CREEK PHARMACY LLC
Entity Type:Organization
Organization Name:DRY CREEK PHARMACY LLC
Other - Org Name:DRY CREEK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-647-5518
Mailing Address - Street 1:3300 N RUNNING CREEK WAY
Mailing Address - Street 2:BLDG G SUITE 100
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-331-6630
Mailing Address - Fax:801-331-6495
Practice Address - Street 1:3300 N RUNNING CREEK WAY
Practice Address - Street 2:BLDG G SUITE 100
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-331-6630
Practice Address - Fax:801-331-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
UT6892121-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100976OtherPK