Healthcare Provider Details

I. General information

NPI: 1578890695
Provider Name (Legal Business Name): OQUIRRH MOUNTAIN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S 8400 W
MAGNA UT
84044-4907
US

IV. Provider business mailing address

3665 S 8400 W #120
MAGNA UT
84044-4907
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-1000
  • Fax: 801-252-1002
Mailing address:
  • Phone: 801-252-1000
  • Fax: 801-252-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number75052901703
License Number StateUT

VIII. Authorized Official

Name: SHELDON BUYS BIRCH
Title or Position: OWNER
Credential: PHARMD
Phone: 435-850-8772