NPIMap

Organization Active NPI

Canyon Pharmaceutical, LLC

  • Community/Retail Pharmacy
  • Provo, UT
National Provider Identifier
1346282951
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CANYON PHARMACEUTICAL, LLC
Practice address
3179 N Canyon Rd
Provo, UT 84604-3916
Phone
(801) 377-2002
Fax
(801) 377-2007
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Ryan JohansenNPI 1912128513
Title
Owner
Phone
(801) 440-2995

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 50843661703 UT
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

3179 N Canyon Rd
Provo, UT 84604-3916

Mailing address

3179 N Canyon Rd
Provo, UT 84604-3916
Phone (801) 377-2002

Other identifiers 1

IdentifierTypeStateIssuer
710871500008MedicaidUT

Other names 1

  • Rock Canyon Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

3179 N Canyon Rd
Provo, UT 84604
Phone (801) 377-2002

3153 N Canyon Rd
Provo, UT 84604
Phone (801) 377-2002

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1346282951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3179 N CANYON RD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043916",
            "telephone_number": "801-377-2002",
            "fax_number": "801-377-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3179 N CANYON RD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043916",
            "telephone_number": "801-377-2002",
            "fax_number": "801-377-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PHARMACEUTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-440-2995"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "UT",
            "license": "50843661703",
            "primary": false
        },
        {
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710871500008",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Canyon Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.