Healthcare Provider Details

I. General information

NPI: 1407767759
Provider Name (Legal Business Name): ALPINE PED CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3668 W 2150 N STE 100
LEHI UT
84048-7798
US

IV. Provider business mailing address

3668 W 2150 N STE 100
LEHI UT
84048-7798
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-6985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CARLYLE
Title or Position: MANAGER
Credential:
Phone: 801-763-6985