Healthcare Provider Details

I. General information

NPI: 1093228645
Provider Name (Legal Business Name): ECO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 S STATE STREET SUITE 115
SOUTH SALT LAKE CITY UT
84115
US

IV. Provider business mailing address

12523 S CREEK MEADOW RD # 109
RIVERTON UT
84065-7291
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-6111
  • Fax: 801-254-6226
Mailing address:
  • Phone: 801-254-6111
  • Fax: 801-254-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES AMMON
Title or Position: DIRECTOR PHARMACY OPERATIONS
Credential:
Phone: 801-254-6111