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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