Provider Demographics
NPI:1295483782
Name:LION PRIDE PHARMACY AND WELLNESS
Entity type:Organization
Organization Name:LION PRIDE PHARMACY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ PHARMAIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:KEALOHA
Authorized Official - Last Name:HARWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-628-2066
Mailing Address - Street 1:163 W 1600 S STE 3
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6715
Mailing Address - Country:US
Mailing Address - Phone:435-628-2066
Mailing Address - Fax:435-623-2887
Practice Address - Street 1:163 W 1600 S STE 3
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6715
Practice Address - Country:US
Practice Address - Phone:435-628-2066
Practice Address - Fax:435-623-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
No335G00000XSuppliersMedical Foods Supplier