Samuel I Marshall, P,C.
Organization Active NPI Community/Retail Pharmacy · Panguitch, UT
NPI 1326487182 · NPPES record last updated Apr 6, 2022
Key facts
- NPI
- 1326487182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 8715464-1703 (UT)
- Legal business name
- SAMUEL I MARSHALL, P,C.
- Practice address
- 95 E Center
Panguitch, UT 84759-0068 - Phone
- (435) 676-2212
- Fax
- (435) 676-8850
- NPI assigned
- Jun 14, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Samuel Ian Marshall, PHARMD
- Title
- Owner
- Phone
- (435) 590-8621
Practitioners 3
-
Samuel Ian Marshall, PHARMD
-
Jeremiah Daniel Halstead, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140523001525 | UT | Part B Supplier - Mass Immunization (Roster Biller Only) | 3870716673 | Practice locations: Panguitch, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 8715464-1703 | UT | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
95 E Center
Panguitch, UT 84759-0068
Mailing address
PO Box 68
Panguitch, UT 84759-0068
Phone (435) 676-2212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326487182 | Medicaid | UT |
Other names
- Panguitch Drug
Other providers in Panguitch, UT
- Shaunna Michele Rechsteiner
- Alec Reynolds
- Robert L Smith DC PC
- Becky Sue Roberts
- Raigan Rogerson
- Shane R Jensen
- Timothy B Smith
- Southwest Vision, LLC
- Wayne Community Health Center, Inc
- Wayne Community Health Centers Inc.
All providers in Panguitch, UT · Community/Retail Pharmacy in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.