Provider Demographics
NPI:1932527124
Name:ASPEN RIDGE PHARMACY LLC
Entity Type:Organization
Organization Name:ASPEN RIDGE PHARMACY LLC
Other - Org Name:ASPEN RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-896-5438
Mailing Address - Street 1:515 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:UT
Mailing Address - Zip Code:84754-3115
Mailing Address - Country:US
Mailing Address - Phone:435-527-1300
Mailing Address - Fax:435-527-0913
Practice Address - Street 1:515 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:UT
Practice Address - Zip Code:84754-3115
Practice Address - Country:US
Practice Address - Phone:435-527-1300
Practice Address - Fax:435-527-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
UT8945979-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1932527124Medicaid
2145191OtherPK