Provider Demographics
NPI:1790920700
Name:RSP PHARMACEUTICAL CORPORATION
Entity Type:Organization
Organization Name:RSP PHARMACEUTICAL CORPORATION
Other - Org Name:BIRCH FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-882-7775
Mailing Address - Street 1:493 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1654
Mailing Address - Country:US
Mailing Address - Phone:435-882-7775
Mailing Address - Fax:435-882-7779
Practice Address - Street 1:493 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-882-7775
Practice Address - Fax:435-882-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7643843-1703333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid