MEDICARE: PHARMACY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	8184721-1704	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2101153	OTHER		PK

General Provider Information

NPI Number	:	1093803215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 26667
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84126-0667
Country	:	US
Telephone Number	:	801-302-8555
Fax Number	:	801-302-8600

Provider Business Practice Location Address
First Line	:	2235 S 1300 W STE D
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-7242
Country	:	US
Telephone Number	:	801-302-8555
Fax Number	:	801-302-8600

Authorized Official
Title or Position	:	OWNER
Name	:	BRYAN NICHOLS
Credential	:
Telephone Number	:	801-302-8555

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/02/2014

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Directions to “PHARMACY SERVICES LLC ” Practice Location

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