Main Street Drug & Boutique, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MAIN STREET DRUG & BOUTIQUE, INC.

Practice address

140 S Main St
Monticello, UT 84535-7728

Phone

(435) 587-2302

Fax

(435) 587-3441

NPI assigned

Dec 9, 2021

Last updated

Dec 9, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tyler Gilson, PHARMD

Title

President/Pharmacist

Phone

(435) 650-2736

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Robert Young, PHARMD

  • Pharmacist
  • Monticello, UT
  • NPI 1073108247
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1073272852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 519",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "845350519",
            "telephone_number": "435-587-2302",
            "fax_number": "435-587-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S MAIN ST",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "845357728",
            "telephone_number": "435-587-2302",
            "fax_number": "435-587-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DRUG & BOUTIQUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-02",
        "status": "A",
        "authorized_official_last_name": "GILSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
        "authorized_official_telephone_number": "435-650-2736",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Marvin Jeppesen, MD
• Michael James Judi, DMD
• Kayenta Dental (Monticello Dental)
• Dylan Naylor Knight, DC
• Kade Shumway Lyman
• Main Street Pharmacare LLC (Main Street Drug and Gift)
• Allie Maughan, RD
• Thomas Rhett Maughan, D.C.
• Daniel C Mower, CRNA
• Francesca R. Nichols, MD

• Community/Retail Pharmacy in Monticello, UT
• Providers in Monticello, UT by specialty
• Community/Retail Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.