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Organization
LIFECARE SPECIALTY
Active
Organization
LIFECARE SPECIALTY
Active
Other names
Lifecare Specialty
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYLER L NIXON RPH (OWNER)
(801) 676-0078
Entity
Organization
Contact information
Practice address
1646 SUNRISE PLACE STE B, WEST JORDAN, UT 84084
(801) 676-0078
(801) 676-0079
Mailing address
1646 SUNRISE PLACE STE B, WEST JORDAN, UT 84084
(801) 676-0078
(801) 676-0079
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
—
NULL
3336H0001X
Home Infusion Therapy Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
8473547-1704
UT
3336M0002X
Mail Order Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
84735471704
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4612481
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/14/2013
Last updated
06/07/2018
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