Provider Demographics
NPI:1558391441
Name:STAPLEY PHARMACY INC
Entity Type:Organization
Organization Name:STAPLEY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-673-3575
Mailing Address - Street 1:102 E CITY CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3460
Mailing Address - Country:US
Mailing Address - Phone:435-673-3575
Mailing Address - Fax:435-673-2141
Practice Address - Street 1:102 E CITY CENTER ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3460
Practice Address - Country:US
Practice Address - Phone:435-673-3575
Practice Address - Fax:435-673-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5683021-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4602846OtherNABP OR NCPDP
UT870255793003Medicaid
UT052421001Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION