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General NPI Number Information
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NPI Number | 1366748238
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Entity Type | Organization
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Legal Business Name | MOUNT OLYMPUS COMPOUNDING LLC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 392 E 12300 S SUITE A
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City | DRAPER
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State | UT
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Zip | 84020-8181
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Country | US
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Telephone | 801-278-9008
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Fax | 801-849-0399
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Provider Business Mailing Address
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Address Line | PO BOX 1344
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City | DRAPER
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State | UT
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Zip | 84020-1344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER, LLC
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Name | MRS. ANGIE KILPATRICK
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Credential |
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Telephone | 801-824-6968
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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 | 87645041703
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 87645041703
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License Number State | UT
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