MEDICARE: KIRKPATRICK DRUG LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	61282181703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2100845	OTHER		PK

General Provider Information

NPI Number	:	1306826128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKPATRICK DRUG LLC

Provider Business Mailing Address
First Line	:	270 E STATE RD 73
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045
Country	:	US
Telephone Number	:	801-766-4894
Fax Number	:	801-766-4896

Provider Business Practice Location Address
First Line	:	270 E CROSSROADS BLVD
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84043-2966
Country	:	US
Telephone Number	:	801-766-4894
Fax Number	:	801-766-4896

Authorized Official
Title or Position	:	OWNER
Name	:	JEFF KIRKPATRICK
Credential	:	RPH
Telephone Number	:	801-885-8241

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	06/12/2013

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Directions to “KIRKPATRICK DRUG LLC ” Practice Location

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