Provider Demographics
NPI:1659859965
Name:BETTERCARE FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:BETTERCARE FAMILY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAKSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-450-0747
Mailing Address - Street 1:545 COLUMBIA LN
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2450
Mailing Address - Country:US
Mailing Address - Phone:385-477-4942
Mailing Address - Fax:385-477-4945
Practice Address - Street 1:545 COLUMBIA LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2450
Practice Address - Country:US
Practice Address - Phone:385-477-4942
Practice Address - Fax:385-477-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10901846-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184940835OtherNPI NUMBER
UT3008051Medicaid