Canyon Pharmaceutical, LLC
Pharmacy, Community/Retail Pharmacy in Provo, UT. Organization (NPI-2).
NPI number1346282951
StatusActive
Last updated in NPPESAug 15, 2022
Details
- NPI
- 1346282951
- Entity type
- Organization (NPI-2)
- Legal business name
- Canyon Pharmaceutical, LLC
- Organization subpart
- No
- Enumeration date
- Jun 11, 2006
- Certification date
- Aug 15, 2022
- Last updated
- Aug 15, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 183500000X | Pharmacist | 50843661703 | UT | |
| 3336C0004X | Pharmacy, Compounding Pharmacy | – | – |
Other names
- Rock Canyon Pharmacy (Doing Business As)
Practice location
3179 N Canyon RdProvo, UT 84604-3916
Phone 801-377-2002 · Fax 801-377-2007
Mailing address
3179 N Canyon RdProvo, UT 84604-3916
Phone 801-377-2002 · Fax 801-377-2007
Authorized official
Ryan Johansen
Owner
8014402995
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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