Healthcare Provider Details

I. General information

NPI: 1114850997
Provider Name (Legal Business Name): SPECIALTY SALES & SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 N MAIN ST STE 250D
LOGAN UT
84321-2537
US

IV. Provider business mailing address

580 N MAIN ST STE 250D
LOGAN UT
84321-2537
US

V. Phone/Fax

Practice location:
  • Phone: 801-679-1874
  • Fax: 801-679-1875
Mailing address:
  • Phone: 801-679-1874
  • Fax: 801-679-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ZELLER
Title or Position: MANAGER
Credential:
Phone: 801-850-1330