Provider Demographics
NPI:1528525508
Name:SKULL VALLEY HEALTH CLINIC
Entity type:Organization
Organization Name:SKULL VALLEY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAFFARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-850-1825
Mailing Address - Street 1:1929 N AARON DR STE I
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8112
Mailing Address - Country:US
Mailing Address - Phone:435-850-1825
Mailing Address - Fax:844-847-4640
Practice Address - Street 1:1929 N AARON DR STE I
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-8112
Practice Address - Country:US
Practice Address - Phone:435-850-1825
Practice Address - Fax:844-847-4640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKULL VALLEY HEALTH CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy