Provider Demographics
NPI:1093803215
Name:PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:PHARMACY SERVICES LLC
Other - Org Name:FIVE STAR SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-302-8555
Mailing Address - Street 1:PO BOX 26667
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0667
Mailing Address - Country:US
Mailing Address - Phone:801-302-8555
Mailing Address - Fax:801-302-8600
Practice Address - Street 1:2235 S 1300 W STE D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7242
Practice Address - Country:US
Practice Address - Phone:801-302-8555
Practice Address - Fax:801-302-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8184721-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101153OtherPK