Healthcare Provider Details

I. General information

NPI: 1114068079
Provider Name (Legal Business Name): M AND M PRESCRIPTION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11585 S STATE ST STE 103
DRAPER UT
84020-7403
US

IV. Provider business mailing address

PO BOX 901388
SANDY UT
84090-1388
US

V. Phone/Fax

Practice location:
  • Phone: 801-890-0346
  • Fax: 801-542-0491
Mailing address:
  • Phone: 801-252-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number86909741704
License Number StateUT

VIII. Authorized Official

Name: KEVIN HAGEN
Title or Position: PRES
Credential:
Phone: 801-252-9790