Healthcare Provider Details

I. General information

NPI: 1861780439
Provider Name (Legal Business Name): BIRCH PHARMACEUTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6727 N. HWY 36
TOOELE UT
84074
US

IV. Provider business mailing address

4776 N AUTUMNCOVE
ERDA UT
84074-9372
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-8880
  • Fax: 435-882-8881
Mailing address:
  • Phone: 435-882-8880
  • Fax: 435-882-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8055593-1703
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHELDON BIRCH
Title or Position: OWNER
Credential: PHARMD
Phone: 435-882-7775