Provider Demographics
NPI:1881677722
Name:BEAVER VALLEY PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:BEAVER VALLEY PHARMACY SERVICES INC
Other - Org Name:BEAVER DRUG FLORAL AND GIFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-438-2588
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:98 N MAIN ST
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1438
Mailing Address - Country:US
Mailing Address - Phone:435-438-2588
Mailing Address - Fax:
Practice Address - Street 1:98 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-1438
Practice Address - Country:US
Practice Address - Phone:435-438-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1097570001Medicaid
UT1097570001Medicare ID - Type Unspecified