Provider Demographics
NPI:1790157261
Name:GLOBAL MEDICAL THERAPEUTICS INC
Entity Type:Organization
Organization Name:GLOBAL MEDICAL THERAPEUTICS INC
Other - Org Name:GLOBAL MEDICAL THERAPEUTICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MAYSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-518-1327
Mailing Address - Street 1:1890 S 3850 W STE 121-A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-4909
Mailing Address - Country:US
Mailing Address - Phone:801-935-4305
Mailing Address - Fax:801-953-0908
Practice Address - Street 1:1890 S 3850 W STE 121-A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104
Practice Address - Country:US
Practice Address - Phone:801-935-4305
Practice Address - Fax:801-953-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
UT10923754-17033336C0003X
UT9543939-1704333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155240OtherPK