Healthcare Provider Details

I. General information

NPI: 1407790918
Provider Name (Legal Business Name): GLYCOCARE DME MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S HIGHWAY 89
NORTH SALT LAKE UT
84054-2543
US

IV. Provider business mailing address

195 S HIGHWAY 89
NORTH SALT LAKE UT
84054-2543
US

V. Phone/Fax

Practice location:
  • Phone: 307-289-2158
  • Fax:
Mailing address:
  • Phone: 307-289-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ZAFAR TARIQ
Title or Position: OWNER
Credential:
Phone: 307-289-2158