Healthcare Provider Details

I. General information

NPI: 1770478265
Provider Name (Legal Business Name): VYV RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S MEDICAL DR STE 102
BRIGHAM CITY UT
84302-4715
US

IV. Provider business mailing address

1017 MEDICAL DR
BRIGHAM CITY UT
84302-3049
US

V. Phone/Fax

Practice location:
  • Phone: 435-232-5534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding 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: ANDREW CANNON
Title or Position: MEMBER/PHARMACIST
Credential: PHARMD
Phone: 801-633-7974