=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578890695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OQUIRRH MOUNTAIN PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2009
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3665 S 8400 W
-----------------------------------------------------
City | MAGNA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84044-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-252-1000
-----------------------------------------------------
Fax | 801-252-1002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3665 S 8400 W #120
-----------------------------------------------------
City | MAGNA
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84044-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-252-1000
-----------------------------------------------------
Fax | 801-252-1002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHELDON BUYS BIRCH
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 435-850-8772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 75052901703
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------