Provider Demographics
NPI:1477759678
Name:LOVE INFUSION PHARMACY LLC
Entity Type:Organization
Organization Name:LOVE INFUSION PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-973-0900
Mailing Address - Street 1:1405 W 2200 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1485
Mailing Address - Country:US
Mailing Address - Phone:801-973-0900
Mailing Address - Fax:801-973-9571
Practice Address - Street 1:1405 W 2200 S
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1485
Practice Address - Country:US
Practice Address - Phone:801-973-0900
Practice Address - Fax:801-973-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6579375-17043336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6579375-1704OtherPHARMACY LICENSE-CLASS B
UT6579375-8913OtherCONTROLLED SUBSTANCE
UT6003700002Medicare NSC