Provider Demographics
NPI:1437627288
Name:TAYLOR DRUG OF LINDON
Entity Type:Organization
Organization Name:TAYLOR DRUG OF LINDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-440-1222
Mailing Address - Street 1:69 E HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5598
Mailing Address - Country:US
Mailing Address - Phone:801-369-3796
Mailing Address - Fax:801-756-1181
Practice Address - Street 1:265 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042
Practice Address - Country:US
Practice Address - Phone:385-440-1222
Practice Address - Fax:385-489-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1437627288Medicaid