Provider Demographics
NPI:1952657934
Name:TIBBITTS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:TIBBITTS FAMILY PHARMACY LLC
Other - Org Name:TIBBITTS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-771-0363
Mailing Address - Street 1:2940 N CHURCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6503
Mailing Address - Country:US
Mailing Address - Phone:801-771-0363
Mailing Address - Fax:801-771-0506
Practice Address - Street 1:2940 N CHURCH ST STE 201
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6503
Practice Address - Country:US
Practice Address - Phone:801-771-0363
Practice Address - Fax:801-771-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT8393226-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4612265OtherNCPDP PROVIDER IDENTIFICATION NUMBER