Provider Demographics
NPI:1649497538
Name:PHARMACEUTICAL AND DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:PHARMACEUTICAL AND DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-485-3344
Mailing Address - Street 1:1152 W 2240 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-7236
Mailing Address - Country:US
Mailing Address - Phone:801-485-3344
Mailing Address - Fax:801-485-1982
Practice Address - Street 1:1152 W 2240 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7236
Practice Address - Country:US
Practice Address - Phone:801-485-3344
Practice Address - Fax:801-485-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5738619-17103336N0007X
UT5738405-17043336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy