Healthcare Provider Details

I. General information

NPI: 1477759678
Provider Name (Legal Business Name): LOVE INFUSION PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 W 2200 S SUITE 201
SALT LAKE CITY UT
84119-1485
US

IV. Provider business mailing address

1405 W 2200 S SUITE 201
SALT LAKE CITY UT
84119-1485
US

V. Phone/Fax

Practice location:
  • Phone: 801-973-0900
  • Fax: 801-973-9571
Mailing address:
  • Phone: 801-973-0900
  • Fax: 801-973-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number6579375-1704
License Number StateUT

VIII. Authorized Official

Name: MR. JOSHUA LOVE
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 801-973-0900