Provider Demographics
NPI:1013217736
Name:ACUPHARM LLC
Entity Type:Organization
Organization Name:ACUPHARM LLC
Other - Org Name:ACUPHARM, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMASS
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:801-456-4505
Mailing Address - Street 1:990 W ATHERTON DR # 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3465
Mailing Address - Country:US
Mailing Address - Phone:801-456-4505
Mailing Address - Fax:801-456-4508
Practice Address - Street 1:990 W ATHERTON DR # 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-3465
Practice Address - Country:US
Practice Address - Phone:801-456-4505
Practice Address - Fax:801-456-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
UT1076429317043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127314OtherPK