Provider Demographics
NPI:1639842255
Name:GUNNISON VALLEY HOSPITAL
Entity Type:Organization
Organization Name:GUNNISON VALLEY HOSPITAL
Other - Org Name:MANTI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-528-2146
Mailing Address - Street 1:46 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-1254
Mailing Address - Country:US
Mailing Address - Phone:435-835-7250
Mailing Address - Fax:435-835-7249
Practice Address - Street 1:46 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642-1254
Practice Address - Country:US
Practice Address - Phone:435-835-7250
Practice Address - Fax:435-835-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy