Provider Demographics
NPI:1942686761
Name:STAPLEY PHARMACY, INC.
Entity Type:Organization
Organization Name:STAPLEY PHARMACY, INC.
Other - Org Name:STAPLEY PHARMACY ENTERPRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-3575
Mailing Address - Street 1:167 E. MAIN STREET
Mailing Address - Street 2:PO BOX 1057
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725
Mailing Address - Country:US
Mailing Address - Phone:435-878-2300
Mailing Address - Fax:435-878-2301
Practice Address - Street 1:167 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-878-2300
Practice Address - Fax:435-878-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT948424617033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153104OtherPK