Provider Demographics
NPI:1912911876
Name:ZION PHARMACY
Entity Type:Organization
Organization Name:ZION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STIRLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-644-2693
Mailing Address - Street 1:14 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3542
Mailing Address - Country:US
Mailing Address - Phone:435-644-2702
Mailing Address - Fax:435-644-8167
Practice Address - Street 1:14 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3542
Practice Address - Country:US
Practice Address - Phone:435-644-2702
Practice Address - Fax:435-644-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528789543-001Medicaid
UT528789543-001Medicaid