Provider Demographics
NPI:1174559330
Name:PAYSON FOOD CORPORATION INC.
Entity type:Organization
Organization Name:PAYSON FOOD CORPORATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
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 1:586 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3428
Practice Address - Country:US
Practice Address - Phone:801-465-2343
Practice Address - Fax:801-465-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332540-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4608521OtherNCPDP
UT=========001Medicaid
UT1218760001Medicare NSC
UTX62759Medicare UPIN