1821432626 NPI number — ISOMERIC PHARMACY SOLUTIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821432626 NPI number — ISOMERIC PHARMACY SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISOMERIC PHARMACY SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ISOMERIC PHARMACY SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821432626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 S FOOTHILL DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84109-1479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-418-0730
Provider Business Mailing Address Fax Number:
801-505-0380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 S FOOTHILL DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84109-1479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-418-0730
Provider Business Practice Location Address Fax Number:
801-505-0380
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CORSI
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
Authorized Official Title or Position:
QA DIRECTOR
Authorized Official Telephone Number:
800-418-0730

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 9266865-1703 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2140132 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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