Healthcare Provider Details

I. General information

NPI: 1538467360
Provider Name (Legal Business Name): MOYER HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 W MAPLE LOOP DR SUITE 304A
LEHI UT
84043-5661
US

IV. Provider business mailing address

2940 W MAPLE LOOP DR SUITE 304A
LEHI UT
84043-5661
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-0532
  • Fax: 801-407-1676
Mailing address:
  • Phone: 801-997-0532
  • Fax: 801-407-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7903034-1704
License Number StateUT

VIII. Authorized Official

Name: JASON MOYER
Title or Position: OWNER
Credential:
Phone: 801-358-0009