1386980944 NPI number — CD PHARMACY LLC

Table of content: (NPI 1386980944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386980944 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:
Provider Other Organization Name Type Code:
6
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:
1386980944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2024
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
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
SLC
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-2981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-433-9500
Provider Business Mailing Address Fax Number:
801-433-9333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 S 900 E STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84102-2959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-433-9500
Provider Business Practice Location Address Fax Number:
801-433-9333
Provider Enumeration Date:
12/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NORRIS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-433-9500

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  8627028-1704 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2139564 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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