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General NPI Number Information
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NPI Number | 1649643909
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Entity Type | Organization
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Legal Business Name | ECO PHARMACY OF SALT LAKE CITY 1 LLC
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 05/27/2016
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Provider Practice Location Address
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Address Line | 12523 S CREEK MEADOW DR
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City | RIVERTON
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State | UT
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Zip | 84065-7291
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Country | US
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Telephone | 801-254-6111
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Fax | 801-251-6226
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Provider Business Mailing Address
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Address Line | 12523 S CREEK MEADOW DR
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City | RIVERTON
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State | UT
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Zip | 84065-7291
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Country | US
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Telephone | 801-254-6111
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Fax | 801-251-6226
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Authorized Official
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Title or Position | OWNER, AO
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Name | JASMEET SINGH
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Credential |
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Telephone | 832-859-9523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9301773-1703
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License Number State | UT
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