12TH ST PHARMACY INC (NPI# 1538284716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538284716 |
| Entity Type | Organization |
| Organization Name | 12TH ST PHARMACY INC |
| Other Organization Name | 12TH STREET PHARMACY |
| Practice Address |
698 12th St Ogden UT 84404-6200 |
| Practice Telephone | 8016212154 |
| Practice Fax Number | 8016279523 |
| Mailing Telephone | 8016212154 |
| Mailing Fax Number | 8016279523 |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-09-23 |
| Authorized Official Name | WALLACE EGGLESTON (OWNER AND PHARMACIST) |
| Authorized Official Telephone | 8016212154 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
362500-1703 | UT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2100182 | 01 |
| Other Name | Type Code |
|---|---|
| 12TH STREET PHARMACY | Doing Business As Name - Organization |
| Street Address |
698 12TH ST |
| City | OGDEN |
| State | UT |
| Zip Code | 84404-6200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104888718 | Danette Stuart | Physician Assistant | 698 12th St, Ogden, UT 84404-6200 | 2006-04-06 |
| 1720464936 | Kimberly Michelle Zia | Physician Assistant | 698 12th St, Ogden, UT 84404-6200 | 2015-08-11 |
| 1942550181 | Auralcare Hearing Centers of America, LLC | Clinic/Center | 698 12th St, Ogden, UT 84404-6200 | 2012-09-14 |
| 1396024618 | Jessica Dunn | Nurse Practitioner | 698 12th St, Ogden, UT 84404-6200 | 2011-08-04 |
| 1013119726 | Dixie Allen | Counselor | 698 12th St, Ogden, UT 84404-5877 | 2007-06-04 |
| 1720204456 | Evelyn Geilmann | Nurse Practitioner | 698 12th St, Ogden, UT 84404-6200 | 2007-04-18 |
| 1912072570 | Garth Reid | Physician Assistant | 698 12th St, Ogden, UT 84404-5877 | 2006-11-21 |
| 1558394692 | Joelle M Creager | Nurse Practitioner | 698 12th St, Ogden, UT 84404-5877 | 2006-07-09 |
| 1700818259 | Scott M Stallings | Family Medicine | 698 12th St, Ogden, UT 84404-5877 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881159648 | Bingham Marriage & Family Counseling | Counselor | 1812 W 2000 N #1, Ogden, UT 84404 | 2019-02-06 |
| 1609362094 | Hoopes Dental | Dentist | 333 2nd St. Suite 1a, Ogden, UT 84404 | 2018-07-09 |
| 1497241384 | Alysia Cohen | Specialist/Technologist | 1527 9th Street, Ogden, UT 84404 | 2018-07-03 |
| 1235648049 | Walk Perfect, Inc. | Podiatrist | 1069 S. Stewart Dr, Suite 1, Ogden, UT 84404 | 2017-09-25 |
| 1043738602 | Veronica Skidmore | Specialist/Technologist | 3848 Harrison Blvd., Ogden, UT 84404 | 2017-09-05 |
| 1134645526 | Pco-kta, LLC | Pharmacy | 3673 West 2600 North, Plain City, UT 84404 | 2017-08-17 |
| 1568899227 | Alisa Roberts | Marriage & Family Therapist | 1181 Christmas Box Lane, Ogden, UT 84404 | 2013-09-26 |
| 1366796351 | Kenneth Andrew Boothe | Chiropractor | 1920 North 250 West, Suite 24, Ogden, UT 84404 | 2012-10-30 |
| 1760730659 | Mercury Medical LLC | Durable Medical Equipment & Medical Supplies | 3385 W 2525 N, Plain City, UT 84404 | 2012-08-27 |
| 1700131471 | Tina Middleton | Massage Therapist | 1700w 2700n, # 37, Pleasant View, UT 84404 | 2012-07-19 |
| Find all providers in zip 84404 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295829976 | Terrace Pharmacy | Pharmacy | 5167 Adams Ave, #b, Ogden, UT 84405-4522 | 2006-10-03 |
| 1952748519 | Maceys Inc | Pharmacy | 325 36th St, Ogden, UT 84405-1673 | 2013-05-22 |
| 1396827077 | Diversified Professional Company | Pharmacy | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2006-10-20 |
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|---|---|---|---|---|
| 1881292167 | 3bc Incorporated | Pharmacy | 435 North Gateway Drive #802, Providence, UT 84332 | 2020-10-09 |
| 1598371973 | Mountain West Medicine Inc. | Pharmacy | 1551 Renaissance Towne Dr Ste 104, Bountiful, UT 84010-7682 | 2020-09-21 |
| 1518577741 | Black Panda LLC | Pharmacy | 2507 S State St, Salt Lake City, UT 84115-3109 | 2020-08-03 |
| 1235751900 | Roe Rx Inc | Pharmacy | 145 S 3000 W, West Point, UT 84015 | 2020-05-15 |
| 1023637675 | Santaquin Market, Inc. | Pharmacy | 110 N. 400 E., Santaquin, UT 84655 | 2020-04-14 |
| 1891345237 | Strive Pharmacy Utah 1 LLC | Pharmacy | 8928 S State St, Sandy, UT 84070-2246 | 2019-09-17 |
| 1336705755 | Bear Lake Community Health Center | Pharmacy | 517 W 100 N Ste 210, Providence, UT 84332-9826 | 2019-05-10 |
| 1912470246 | Ridley's Family Markets Inc | Pharmacy | 74 S 100 E, Tremonton, UT 84337-1606 | 2019-01-09 |
| 1437620762 | Pthl LLC | Pharmacy | 1890 Bonanza Dr Ste 107, Park City, UT 84060-7217 | 2018-12-16 |
| 1093285785 | Richfield Community Pharmacy LLC | Pharmacy | 440 S Main St Ste B, Richfield, UT 84701-2855 | 2018-11-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.