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NPI Code Detail

MEDICARE: REAMS PHARMACY INC

MEDICARE: REAMS PHARMACY INC
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
13336C0004XCompounding Pharmacy
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy8118754-1703UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12137109OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497023675
Entity Type Code : Organization
Provider Name (Legal Business Name) : REAMS PHARMACY INC
Provider Business Mailing Address
First Line : PO BOX 670
Second Line :
City : DRAPER
State : UT
Zip : 84020-0670
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2783 S STATE ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3634
Country : US
Telephone Number : 801-485-0054
Fax Number : 801-485-0060
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : LORA CHISHOLM
Credential :
Telephone Number : 801-485-0054
Provider Enumeration Date : 12/02/2011
Last Update Date : 07/03/2013

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Directions to “REAMS PHARMACY INC ” Practice Location

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