Provider Demographics
NPI:1679817779
Name:MERIDIAN MEDS, LLC
Entity Type:Organization
Organization Name:MERIDIAN MEDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-331-8291
Mailing Address - Street 1:220 N 1200 E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5862
Mailing Address - Country:US
Mailing Address - Phone:801-331-8291
Mailing Address - Fax:801-331-8037
Practice Address - Street 1:220 N 1200 E
Practice Address - Street 2:SUITE 104
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5862
Practice Address - Country:US
Practice Address - Phone:801-331-8291
Practice Address - Fax:801-331-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
UT8455352-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty