# LIFECARE SPECIALTY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lifecare Specialty
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659612737
- **Authorized official:** MR. TYLER L NIXON RPH (OWNER)
- **Authorized official phone:** (801) 676-0078

## Contact information

- **Practice address:** 1646 SUNRISE PLACE STE B, WEST JORDAN, UT 84084
- **Practice address phone:** (801) 676-0078
- **Practice address fax:** (801) 676-0079
- **Mailing address:** 1646 SUNRISE PLACE STE B, WEST JORDAN, UT 84084
- **Mailing address phone:** (801) 676-0078
- **Mailing address fax:** (801) 676-0079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336H0001X | Home Infusion Therapy Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 8473547-1704 | UT | Yes |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | 84735471704 | UT | — |

## Other

- **Enumeration date:** 03/14/2013
- **Last updated:** 06/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4612481 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |