Healthcare Provider Details

I. General information

NPI: 1629454772
Provider Name (Legal Business Name): MEDS IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD SUITE 101
SALT LAKE CITY UT
84117-7054
US

IV. Provider business mailing address

4624 S HOLLADAY BLVD SUITE 101
SALT LAKE CITY UT
84117-7054
US

V. Phone/Fax

Practice location:
  • Phone: 801-316-0790
  • Fax:
Mailing address:
  • Phone: 801-316-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9471212-1703
License Number StateUT

VIII. Authorized Official

Name: DANIEL RICHARDS
Title or Position: OWNER
Credential:
Phone: 801-316-0790