Provider Demographics
NPI:1336996602
Name:BADGER MANAGEMENT LLC
Entity type:Organization
Organization Name:BADGER MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:435-774-4150
Mailing Address - Street 1:505 E 1400 N STE 110
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2459
Mailing Address - Country:US
Mailing Address - Phone:435-774-4150
Mailing Address - Fax:435-774-4166
Practice Address - Street 1:4935 OLD HIGHWAY RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050
Practice Address - Country:US
Practice Address - Phone:435-774-4150
Practice Address - Fax:435-774-4166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BADGER MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy