# MEDSOURCE RX PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medsource RX Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063736304
- **Authorized official:** SAHILY PAOLINE (PIC)
- **Authorized official phone:** (888) 702-2195

## Contact information

- **Practice address:** 9883 S 500 W, SANDY, UT 84070-2561
- **Practice address phone:** (801) 727-1979
- **Practice address fax:** (855) 332-9272
- **Mailing address:** 9883 S 500 W, SANDY, UT 84070-2561
- **Mailing address phone:** (801) 727-0080
- **Mailing address fax:** (855) 332-9272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 7609917-1703 | UT | Yes |

## Other

- **Enumeration date:** 03/16/2010
- **Last updated:** 10/11/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2123919 | PK | — |