Provider Demographics
NPI:1306826128
Name:KIRKPATRICK DRUG LLC
Entity Type:Organization
Organization Name:KIRKPATRICK DRUG LLC
Other - Org Name:KIRKPATRICK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-885-8241
Mailing Address - Street 1:270 E STATE RD 73
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045
Mailing Address - Country:US
Mailing Address - Phone:801-766-4894
Mailing Address - Fax:801-766-4896
Practice Address - Street 1:270 E CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84043-2966
Practice Address - Country:US
Practice Address - Phone:801-766-4894
Practice Address - Fax:801-766-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
UT612821817033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100845OtherPK
2100845OtherPK
2100845OtherPK