Provider Demographics
NPI:1255659470
Name:MEDS FOR VETS
Entity Type:Organization
Organization Name:MEDS FOR VETS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-255-7666
Mailing Address - Street 1:585 W 9400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2569
Mailing Address - Country:US
Mailing Address - Phone:801-255-7666
Mailing Address - Fax:801-255-7690
Practice Address - Street 1:585 W 9400 S STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2569
Practice Address - Country:US
Practice Address - Phone:801-255-7666
Practice Address - Fax:801-255-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5906468-17033336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4611150OtherNCPDP