Provider Demographics
NPI:1770021388
Name:CRIMSON VALLEY PHARMACY LLC
Entity Type:Organization
Organization Name:CRIMSON VALLEY PHARMACY LLC
Other - Org Name:CRIMSON VALLEY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-218-7744
Mailing Address - Street 1:2351 S RIVER RD
Mailing Address - Street 2:STE #3
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8280
Mailing Address - Country:US
Mailing Address - Phone:435-218-7744
Mailing Address - Fax:
Practice Address - Street 1:2351 S RIVER RD
Practice Address - Street 2:STE 3
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8280
Practice Address - Country:US
Practice Address - Phone:435-218-7744
Practice Address - Fax:435-218-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
UT102228906-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167514OtherPK