Provider Demographics
NPI:1407920259
Name:SHARED PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:SHARED PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-262-6980
Mailing Address - Street 1:4843 S MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2679
Mailing Address - Country:US
Mailing Address - Phone:801-262-6980
Mailing Address - Fax:801-263-1587
Practice Address - Street 1:4843 S MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2679
Practice Address - Country:US
Practice Address - Phone:801-262-6980
Practice Address - Fax:801-263-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8141207-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805497900Medicaid
WY1906530Medicaid
ID805497900Medicaid