Healthcare Provider Details

I. General information

NPI: 1669767356
Provider Name (Legal Business Name): EVEREST PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9883 S 500 W
SANDY UT
84070-2561
US

IV. Provider business mailing address

9883 S 500 W
SANDY UT
84070-2561
US

V. Phone/Fax

Practice location:
  • Phone: 801-727-1964
  • Fax: 888-520-8838
Mailing address:
  • Phone: 877-540-4748
  • Fax: 877-217-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number79911841703
License Number StateUT

VIII. Authorized Official

Name: DAVID DIEHL
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 888-702-1197