Provider Demographics
NPI:1376264432
Name:KTM PHARMACY
Entity Type:Organization
Organization Name:KTM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-817-5559
Mailing Address - Street 1:2564 E MOUNTAIN LEDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5052
Mailing Address - Country:US
Mailing Address - Phone:435-817-5559
Mailing Address - Fax:
Practice Address - Street 1:1483 E 3850 S UNIT B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6233
Practice Address - Country:US
Practice Address - Phone:435-628-0842
Practice Address - Fax:435-628-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy