Healthcare Provider Details

I. General information

NPI: 1205959335
Provider Name (Legal Business Name): MOUNTAIN CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W BELLWOOD LN
MURRAY UT
84123-4494
US

IV. Provider business mailing address

1030 W BELLWOOD LN
MURRAY UT
84123-4494
US

V. Phone/Fax

Practice location:
  • Phone: 801-747-7191
  • Fax: 801-747-7192
Mailing address:
  • Phone: 801-747-7191
  • Fax: 801-747-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number7478838-1704
License Number StateUT

VIII. Authorized Official

Name: JARED STONG
Title or Position: OWNER
Credential: PHRMD
Phone: 801-747-7191