Healthcare Provider Details

I. General information

NPI: 1437573649
Provider Name (Legal Business Name): COLD FRONT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E 3900 S SUITE 150
SALT LAKE CITY UT
84107-1677
US

IV. Provider business mailing address

339 E 3900 S SUITE 150
SALT LAKE CITY UT
84107-1677
US

V. Phone/Fax

Practice location:
  • Phone: 801-350-1674
  • Fax:
Mailing address:
  • Phone: 801-350-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. LUCAS N HENDRICKS
Title or Position: CEO
Credential:
Phone: 801-350-1674