Healthcare Provider Details

I. General information

NPI: 1497023675
Provider Name (Legal Business Name): REAMS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 S STATE ST
SALT LAKE CITY UT
84115-3634
US

IV. Provider business mailing address

PO BOX 670
DRAPER UT
84020-0670
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-0054
  • Fax: 801-485-0060
Mailing address:
  • Phone:
  • Fax:

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 Number8118754-1703
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LORA CHISHOLM
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 801-485-0054