Organization
MOBILE VIVITROL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G. RICHARDS (OWNER)
(801) 898-7778
Entity
Organization
Contact information
Practice address
13032 SNOW CREST CR, DRAPER, UT 84020
(801) 898-7778
Mailing address
PO BOX 639, DRAPER, UT 84020
(801) 558-6564
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
02/19/2020
Last updated
03/12/2021
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