MEDICARE: RENE LOMELI PHARMD

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	183500000X	Pharmacist	20369	CO

General Provider Information

NPI Number	:	1356867071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE LOMELI PHARMD

Provider Business Mailing Address
First Line	:	2875 DECKER LAKE DR STE 300
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2382
Country	:	US
Telephone Number	:	800-654-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 DECKER LAKE DR STE 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-2382
Country	:	US
Telephone Number	:
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	03/04/2024

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