Provider Demographics
NPI:1801409065
Name:CONGER DRUG INC
Entity Type:Organization
Organization Name:CONGER DRUG INC
Other - Org Name:REEDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECH
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-245-6422
Mailing Address - Street 1:790 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYRUM
Mailing Address - State:UT
Mailing Address - Zip Code:84319-1408
Mailing Address - Country:US
Mailing Address - Phone:435-245-6422
Mailing Address - Fax:435-245-5306
Practice Address - Street 1:790 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1408
Practice Address - Country:US
Practice Address - Phone:435-245-6422
Practice Address - Fax:435-245-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy