Stewart Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9534004-1703 Issued in UT

Legal business name

STEWART PHARMACY, LLC

Practice address

245 W Highway 40
Roosevelt, UT 84066-3712

Phone

(435) 722-2454

Fax

(435) 722-4191

NPI assigned

Oct 12, 2015

Organization subpart

No

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

Authorized official

Name

Brandon Luke, PHARMD

Title

Pharmacy Manager

Phone

(435) 722-2454

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stewarts Basin Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in UT2 enrollments

Enrollment records 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cory Alan Christensen, RPH

  • Pharmacist
  • Roosevelt, UT
  • NPI 1316990518
  NPD (past)
• Jeffrey Brinkerhoff Luke, RPH

  • Pharmacist
  • Roosevelt, UT
  • NPI 1508817123
  NPD (past)

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1124499553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 W HIGHWAY 40",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840663712",
            "telephone_number": "435-722-2454",
            "fax_number": "435-722-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 W HIGHWAY 40",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840663712",
            "telephone_number": "435-722-2454",
            "fax_number": "435-722-4191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEWART PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-12",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "LUKE",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "435-722-2454",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "9534004-1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9534004-1703",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stewarts Basin Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gregory L Staker, MD
• Shannon R Staker, MD
• Aaron Bagley Stevens, DO
• Anna Michelle Stevens
• Chet David Stevens
• Albert Simon Stone, PA-C
• Melissa Faith Stubbs
• Carson Dayton Summers, OD
• Peter Lee Tanner, M.D.
• Alicia E Taylor

• Community/Retail Pharmacy in Roosevelt, UT
• Providers in Roosevelt, 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 May 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.