Healthcare Provider Details

I. General information

NPI: 1669123279
Provider Name (Legal Business Name): NOMI PHARMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3696 W 2100 S
SALT LAKE CITY UT
84120-1202
US

IV. Provider business mailing address

3696 W 2100 S
SALT LAKE CITY UT
84120-1202
US

V. Phone/Fax

Practice location:
  • Phone: 385-375-6555
  • Fax:
Mailing address:
  • Phone: 385-375-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA WALKER
Title or Position: COO
Credential:
Phone: 801-599-8859