Provider Demographics
NPI:1467686758
Name:EZ RX INC
Entity Type:Organization
Organization Name:EZ RX INC
Other - Org Name:EZ PASS RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R. DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-5900
Mailing Address - Street 1:450 S 400 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4938
Mailing Address - Country:US
Mailing Address - Phone:801-397-5900
Mailing Address - Fax:801-397-5910
Practice Address - Street 1:450 S 400 E
Practice Address - Street 2:STE 50
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4938
Practice Address - Country:US
Practice Address - Phone:801-397-5900
Practice Address - Fax:801-397-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT7303454-17033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4611263OtherNCPDP PROVIDER IDENTIFICATION NUMBER