Provider Demographics
NPI:1154411601
Name:ABC ENTERPRISES I, LLC
Entity type:Organization
Organization Name:ABC ENTERPRISES I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-851-1510
Mailing Address - Street 1:1050 SOUTH MEDICAL DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647
Mailing Address - Country:US
Mailing Address - Phone:435-462-0116
Mailing Address - Fax:
Practice Address - Street 1:1050 SOUTH MEDICAL DRIVE SUITE B
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647
Practice Address - Country:US
Practice Address - Phone:435-462-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy