MEDICARE: AMPHEX PHARMACY, 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	3336C0003X	Community/Retail Pharmacy	8529330-1703	UT

General Provider Information

NPI Number	:	1568703650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPHEX PHARMACY, LLC

Provider Business Mailing Address
First Line	:	3668 S GILROY RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3825
Country	:	US
Telephone Number	:	801-349-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	898 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1508
Country	:	US
Telephone Number	:	801-341-1300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAJIV R SHARMA
Credential	:	PHARM.D.
Telephone Number	:	801-673-5612

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	03/26/2014

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