Provider Demographics
NPI:1689686636
Name:BHB INC
Entity type:Organization
Organization Name:BHB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLMER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:435-283-0340
Mailing Address - Street 1:475 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-4017
Mailing Address - Country:US
Mailing Address - Phone:435-283-0340
Mailing Address - Fax:435-283-0341
Practice Address - Street 1:475 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-4017
Practice Address - Country:US
Practice Address - Phone:435-283-0340
Practice Address - Fax:435-283-0341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENT'S MARKET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT276768-1703183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid
UT0887730001Medicare NSC