Provider Demographics
NPI:1386035087
Name:SP CARE LLC
Entity Type:Organization
Organization Name:SP CARE LLC
Other - Org Name:C3 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-3576
Mailing Address - Street 1:126 E CITY CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3460
Mailing Address - Country:US
Mailing Address - Phone:435-673-3576
Mailing Address - Fax:435-703-2274
Practice Address - Street 1:126 E CITY CENTER ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3460
Practice Address - Country:US
Practice Address - Phone:435-673-3576
Practice Address - Fax:435-703-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9169082-17043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy