Healthcare Provider Details

I. General information

NPI: 1669306403
Provider Name (Legal Business Name): LIONHEART ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 S 265 W STE C
DRAPER UT
84020-5415
US

IV. Provider business mailing address

12411 S 265 W STE C
DRAPER UT
84020-5415
US

V. Phone/Fax

Practice location:
  • Phone: 800-514-1030
  • Fax:
Mailing address:
  • Phone: 800-514-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TREVOR JOLLEY
Title or Position: PHARMACIST
Credential:
Phone: 801-231-4389