Provider Demographics
NPI:1033535166
Name:NEW LIFE PHARMACY LLC
Entity Type:Organization
Organization Name:NEW LIFE PHARMACY LLC
Other - Org Name:NEW LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:SIRTAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-716-7200
Mailing Address - Street 1:9883 S 500 W
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2561
Mailing Address - Country:US
Mailing Address - Phone:801-727-1970
Mailing Address - Fax:
Practice Address - Street 1:9883 S 500 W
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2561
Practice Address - Country:US
Practice Address - Phone:801-716-7200
Practice Address - Fax:801-716-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT8941527-17043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144730OtherPK