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Organization
WASATCH FRONT LTC PHARMACY
Active
Organization
WASATCH FRONT LTC PHARMACY
Active
Other names
Pioneer Pharmacy Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON HAGEN (DIRECTOR OF OPERATIONS)
(801) 890-0346
Entity
Organization
Contact information
Practice address
11585 S STATE ST STE 103, DRAPER, UT 84020-7403
(801) 890-0346
(801) 542-0491
Mailing address
11585 S STATE ST, STE 103, DRAPER, UT 84020-7400
(801) 890-0346
(801) 542-0491
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
9012387-1704
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147019
PK
—
Enumeration date
07/31/2014
Last updated
07/31/2014
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