1134653579 NPI number — CD PHARMACY LLC

Table of content: (NPI 1134653579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134653579 NPI number — CD PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CD PHARMACY 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:
RED ROCK PHARMACY
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:
1134653579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 S 900 E STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLC
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-2959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-712-2088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 E 100 S UNIT 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-703-2900
Provider Business Practice Location Address Fax Number:
435-703-2903
Provider Enumeration Date:
04/12/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NORRIS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
801-712-2088

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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