Provider Demographics
NPI:1538516588
Name:CEDAR DRUG AND GIFT, INC
Entity Type:Organization
Organization Name:CEDAR DRUG AND GIFT, INC
Other - Org Name:CEDAR DRUG AND GIFT, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-7578
Mailing Address - Street 1:755 S MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3653
Mailing Address - Country:US
Mailing Address - Phone:435-586-7578
Mailing Address - Fax:435-267-1500
Practice Address - Street 1:755 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3653
Practice Address - Country:US
Practice Address - Phone:435-586-7578
Practice Address - Fax:435-267-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
UT9795159-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3000006Medicaid
2160241OtherPK