Healthcare Provider Details

I. General information

NPI: 1013525864
Provider Name (Legal Business Name): HRX PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4227 S HIGHLAND DR STE 6
HOLLADAY UT
84124
US

IV. Provider business mailing address

4227 S HIGHLAND DR STE 6
HOLLADAY UT
84124
US

V. Phone/Fax

Practice location:
  • Phone: 605-305-1722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CODY WALKER
Title or Position: OWNER
Credential: PHARMD
Phone: 877-401-4317