Healthcare Provider Details
I. General information
NPI: 1386430338
Provider Name (Legal Business Name): RX.CO PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9151 S PROSPERITY RD STE 100
WEST JORDAN UT
84081-6169
US
IV. Provider business mailing address
9151 S PROSPERITY RD STE 100
WEST JORDAN UT
84081-6169
US
V. Phone/Fax
- Phone: 801-414-8776
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 3336C0003X |
| Taxonomy | Community/Retail Pharmacy |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3336M0002X |
| Taxonomy | Mail Order Pharmacy |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3336S0011X |
| Taxonomy | Specialty Pharmacy |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARK
HEBERT
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 801-414-8776