Provider Demographics
NPI:1629014519
Name:4CARE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:4CARE PHARMACY SERVICES LLC
Other - Org Name:4 CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR TECH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-336-3690
Mailing Address - Street 1:109 W GENTILE ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3000
Mailing Address - Country:US
Mailing Address - Phone:801-336-3690
Mailing Address - Fax:801-336-3001
Practice Address - Street 1:109 W GENTILE ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3000
Practice Address - Country:US
Practice Address - Phone:801-336-3690
Practice Address - Fax:801-336-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
UT6187825-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700447Medicaid
SD8535330Medicaid
2100834OtherPK
ID807641300Medicaid
ID807641300Medicaid