Provider Demographics
NPI:1427119593
Name:B AND H MEDICAL
Entity type:Organization
Organization Name:B AND H MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-373-7288
Mailing Address - Street 1:286 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4419
Mailing Address - Country:US
Mailing Address - Phone:801-373-7288
Mailing Address - Fax:801-373-0673
Practice Address - Street 1:286 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4419
Practice Address - Country:US
Practice Address - Phone:801-373-7288
Practice Address - Fax:801-373-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
UT12765617033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107965OtherPK
UT=========006Medicaid