Provider Demographics
NPI:1093228645
Name:ECO PHARMACY LLC
Entity Type:Organization
Organization Name:ECO PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-254-6111
Mailing Address - Street 1:12523 S CREEK MEADOW RD # 109
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7291
Mailing Address - Country:US
Mailing Address - Phone:801-254-6111
Mailing Address - Fax:801-254-6226
Practice Address - Street 1:3702 S STATE STREET SUITE 115
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:801-254-6111
Practice Address - Fax:801-254-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy