MAIN STREET DRUG & BOUTIQUE, INC. — NPI 1073272852 (Licensed & Credentialed Suppliers — Pharmacy, Community

CMS-1500 Box 24J / 33a • NPI

1073272852

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336C0003X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy

Box 32 Service Location & ZIP+4

140 S MAIN ST, MONTICELLO, UT, 84535-7728

✓ 9-Digit EDI 837 ZIP+4 (84535-7728)

Practice Phone & Referral Fax

(435) 587-2302

Fax: (435) 587-3441

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1073272852 (MAIN STREET DRUG & BOUTIQUE, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1073272852` (NPI-2 Organization / Facility)
Provider / Legal Name	MAIN STREET DRUG & BOUTIQUE, INC.
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy NUCC Code: `3336C0003X` (Pharmacy, Community/Retail Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	140 S MAIN ST, MONTICELLO, UT, 84535-7728
Practice Telephone / Fax	Tel: (435) 587-2302 \| Fax: (435) 587-3441
Administrative Mailing Address	PO BOX 519, MONTICELLO, UT, 84535-0519
Enumeration & Last Sync	Enumerated: 2021-12-09 \| CMS Record Updated: 2021-12-09
Authorized Official	TYLER GILSON (President/Pharmacist)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

140 S MAIN ST, MONTICELLO, UT, 84535-7728

🗺️ Open in Google Maps 🏥 More Providers in MONTICELLO

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Plain-English Taxonomy & CMS Crosswalk (3336C0003X)

What Does Taxonomy Code 3336C0003X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0003X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Community/Retail Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MAIN STREET DRUG & BOUTIQUE, INC.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336C0004X` — Pharmacy, Compounding Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Compounding Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`3336C0003X` — Pharmacy, Community/Retail Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MAIN STREET DRUG & BOUTIQUE, INC. (NPI #1073272852)