Provider Demographics
NPI:1730679085
Name:OAK HILLS PHARMACY LLC
Entity Type:Organization
Organization Name:OAK HILLS PHARMACY LLC
Other - Org Name:OAK HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-560-7095
Mailing Address - Street 1:1750 N WYMOUNT TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602-7600
Mailing Address - Country:US
Mailing Address - Phone:801-422-5171
Mailing Address - Fax:801-422-0812
Practice Address - Street 1:1750 N WYMOUNT TERRACE DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-7600
Practice Address - Country:US
Practice Address - Phone:801-422-5171
Practice Address - Fax:801-422-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-12
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT10752535-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177305OtherPK