Healthcare Provider Details

I. General information

NPI: 1629014519
Provider Name (Legal Business Name): 4CARE PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W GENTILE ST
LAYTON UT
84041-3000
US

IV. Provider business mailing address

109 W GENTILE ST
LAYTON UT
84041-3000
US

V. Phone/Fax

Practice location:
  • Phone: 801-336-3690
  • Fax: 801-336-3001
Mailing address:
  • Phone: 801-336-3690
  • Fax: 801-336-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number6187825-1704
License Number StateUT

VIII. Authorized Official

Name: AMY ANDERSON
Title or Position: SENIOR TECH
Credential:
Phone: 801-336-3690