Skyline Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

131751-1703 Issued in UT

Legal business name

SKYLINE PHARMACY INC.

Practice address

1 W Main St
Mt Pleasant, UT 84647-1327

Phone

(435) 462-2434

Fax

(435) 462-3400

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. David Howard Blackham, RPHNPI 1770668170

Title

Pharmacy Director

Phone

(435) 462-2434

Specialties & licenses 5

Addresses

Other identifiers 2

Locations

Practitioners 2

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.

• David Howard Blackham, RPH

  • Geriatric Pharmacist
  • Mt Pleasant, UT
  • NPI 1770668170
  NPD (past) Authorized official
• Jared Alex Gonzalez, PHARMD

  • Pharmacist
  • Murray, UT
  • NPI 1235023698
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1356426753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W MAIN ST",
            "city": "MT PLEASANT",
            "state": "UT",
            "postal_code": "846471327",
            "telephone_number": "435-462-2434",
            "fax_number": "435-462-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W MAIN ST",
            "city": "MT PLEASANT",
            "state": "UT",
            "postal_code": "846471327",
            "telephone_number": "435-462-2434",
            "fax_number": "435-462-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "BLACKHAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "435-462-2434",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "UT",
            "license": "131751-1703",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "131751-1703",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "UT",
            "license": "131751-1703",
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "UT",
            "license": "131751-1703",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP#",
            "identifier": "4606301",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "840437031001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seely Enterprises (Terrels Pharmacy)
• Susana Elvia Semmens
• Sequel Youth Services of Mt. Pleasant (Mt Pleasant Academy)
• Valery Lynn Shaw, RD
• Lillian Simiskey
• Amberlee Lynn Smith, CSW
• Brian Smith
• Austin Soper, N/A
• Brian L Sorensen, DDS
• Harmony Spencer

• Community/Retail Pharmacy in Mt Pleasant, UT
• Providers in Mt Pleasant, 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 Nov 12, 2007; 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.