Provider Demographics
NPI:1023637675
Name:SANTAQUIN MARKET, INC.
Entity type:Organization
Organization Name:SANTAQUIN MARKET, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEASOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-465-2343
Mailing Address - Street 1:586 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3428
Mailing Address - Country:US
Mailing Address - Phone:801-465-2343
Mailing Address - Fax:801-465-0856
Practice Address - Street 1:110 N. 400 E.
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655
Practice Address - Country:US
Practice Address - Phone:801-465-2343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy