Healthcare Provider Details

I. General information

NPI: 1568703650
Provider Name (Legal Business Name): AMPHEX PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E 3300 S
SALT LAKE CITY UT
84106-1508
US

IV. Provider business mailing address

3668 S GILROY RD
SALT LAKE CITY UT
84109-3825
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-1300
  • Fax:
Mailing address:
  • Phone: 801-349-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8529330-1703
License Number StateUT

VIII. Authorized Official

Name: RAJIV R SHARMA
Title or Position: OWNER
Credential: PHARM.D.
Phone: 801-673-5612