MEDICARE: BROADWAY INC.

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	183500000X	Pharmacist	1173051703	UT
2	1835P1200X	Pharmacotherapy Pharmacist	1173051703	UT

General Provider Information

NPI Number	:	1124180526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY INC.

Provider Business Mailing Address
First Line	:	242 E BROADWAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-2419
Country	:	US
Telephone Number	:	801-363-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 E BROADWAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-2419
Country	:	US
Telephone Number	:	801-363-3939
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER GUS SOTIRIOU
Credential	:	PHARMD
Telephone Number	:	801-363-3939

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/11/2025

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