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General NPI Number Information
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NPI Number | 1295037505
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Entity Type | Organization
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Legal Business Name | ASPIRE RX LLC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 949 E 12400 S A6
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City | DRAPER
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State | UT
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Zip | 84020-8200
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Country | US
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Telephone | 877-221-3464
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Fax | 877-221-3472
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Provider Business Mailing Address
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Address Line | 9883 S 500 W
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City | SANDY
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State | UT
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Zip | 84070-2561
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Country | US
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Telephone | 877-221-3464
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Fax | 877-221-3472
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Authorized Official
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Title or Position | PIC
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Name | JAY ALAN ROACH
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Credential |
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Telephone | 801-727-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7798699-1703
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License Number State | UT
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