Healthcare Provider Details

I. General information

NPI: 1386980944
Provider Name (Legal Business Name): CD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S 900 E STE 150
SLC UT
84102-2959
US

IV. Provider business mailing address

450 S 900 E STE 150
SLC UT
84102-2981
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-9500
  • Fax: 801-433-9333
Mailing address:
  • Phone: 801-433-9500
  • Fax: 801-433-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number8627028-1704
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KENNETH NORRIS
Title or Position: OWNER
Credential:
Phone: 801-433-9500