Healthcare Provider Details

I. General information

NPI: 1225568694
Provider Name (Legal Business Name): MEDS IN MOTION COMPOUNDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W LAWNDALE DR
SALT LAKE CITY UT
84115-2915
US

IV. Provider business mailing address

380 W LAWNDALE DR
SALT LAKE CITY UT
84115-2915
US

V. Phone/Fax

Practice location:
  • Phone: 801-506-6999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number10386992-1704
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL K RICHARDS
Title or Position: OWNER
Credential: PHARM D
Phone: 801-915-9301