Healthcare Provider Details

I. General information

NPI: 1174810014
Provider Name (Legal Business Name): VALUE MED RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 400 E
BOUNTIFUL UT
84010-4938
US

IV. Provider business mailing address

450 S 400 E
BOUNTIFUL UT
84010-4938
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-5900
  • Fax:
Mailing address:
  • Phone: 801-397-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRETT ROBERTSON
Title or Position: MANAGER
Credential:
Phone: 801-296-5113