Healthcare Provider Details

I. General information

NPI: 1104987312
Provider Name (Legal Business Name): DEPOT DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N 2200 W STE 200
SALT LAKE CITY UT
84116-2929
US

IV. Provider business mailing address

1040 N 2200 W STE 200
SALT LAKE CITY UT
84116-2929
US

V. Phone/Fax

Practice location:
  • Phone: 800-331-6353
  • Fax: 801-595-4440
Mailing address:
  • Phone: 800-331-6353
  • Fax: 844-267-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number66418181704
License Number StateUT

VIII. Authorized Official

Name: CURTIS HUGHES
Title or Position: DIRECTOR OF PHARMACY
Credential: B.S PHARMACY
Phone: 801-595-4319