Provider Demographics
NPI:1821182957
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:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONGER
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:2006-10-03
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT557324817033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5520040001Medicaid
2106932OtherPK
2106932OtherPK