OrganizationActive
Diversified Professional Company
NPI 1396827077 · Community/Retail Pharmacy · Ogden, UT
Provider details
- NPI number
- 1396827077
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Gary Bailey, President(801) 479-4030
- License
- 132801-1703 (UT)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4650 Harrison Blvd
Ogden, UT 84403-4303
Phone: (801) 479-4030
Fax: (801) 475-7051
Street-level locationGet directions
Mailing address
Po Box 150010
Ogden, UT 84415-0010
Other names (DBA / former)
- Doing business as
- Peterson Pharmacy
Registry dates
- Enumerated
- 2006-10-20
- Last updated
- 2008-02-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.