Organization
PHARMACY SERVICES LLC
Active
Other names
FIVE STAR SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN NICHOLS (OWNER)
(801) 302-8555
Entity
Organization
Contact information
Practice address
2235 S 1300 W STE D, SALT LAKE CITY, UT 84119-7242
(801) 302-8555
(801) 302-8600
Mailing address
PO BOX 26667, SALT LAKE CITY, UT 84126-0667
(801) 302-8555
(801) 302-8600
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
8184721-1704
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2101153
PK
—
Enumeration date
10/11/2006
Last updated
07/02/2014
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