Active NPI
Market Fresh Inc
- Community/Retail Pharmacy
- Ephraim, UT
National Provider Identifier
1215300660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 9508481-1703
- Legal business name
- MARKET FRESH INC
- Doing business as
- Ephraim Market Fresh Pharmacy
- Practice address
- 475 S Main St
Ephraim, UT 84627-4017 - Phone
- (435) 283-0340
- Fax
- (435) 283-0341
- NPI assigned
- Nov 6, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tyler Merrill
- Title
- President
- Phone
- (435) 851-0261
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 9508481-1703 | UT | Primary |
Addresses
Primary practice location
475 S Main St
Ephraim, UT 84627-4017
Mailing address
475 S Main St
Ephraim, UT 84627-4017
Phone (435) 283-0340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2154991 | Other | PK |
Other names 1
- Ephraim Market Fresh Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210120003139 | UT | Part B Supplier - Mass Immunization (Roster Biller Only) | 5395159032 | Practice locations: Ephraim, UT |
National Provider Directory
National Provider Directory- Tax ID family
- Ephraim Market Fresh Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Ephraim, UT
- NPI 1548633837
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446768000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1457654400000",
"number": "1215300660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 S MAIN ST",
"city": "EPHRAIM",
"state": "UT",
"postal_code": "846274017",
"telephone_number": "435-283-0340",
"fax_number": "435-283-0341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 S MAIN ST",
"city": "EPHRAIM",
"state": "UT",
"postal_code": "846274017",
"telephone_number": "435-283-0340",
"fax_number": "435-283-0341"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARKET FRESH INC",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-06",
"last_updated": "2016-03-11",
"status": "A",
"authorized_official_last_name": "MERRILL",
"authorized_official_first_name": "TYLER",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "435-851-0261"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "UT",
"license": "9508481-1703",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2154991",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Ephraim Market Fresh Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ephraim, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.