Provider Demographics
NPI:1821432626
Name:ISOMERIC PHARMACY SOLUTIONS LLC
Entity Type:Organization
Organization Name:ISOMERIC PHARMACY SOLUTIONS LLC
Other - Org Name:ISOMERIC PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-418-0730
Mailing Address - Street 1:2401 S FOOTHILL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1479
Mailing Address - Country:US
Mailing Address - Phone:800-418-0730
Mailing Address - Fax:801-505-0380
Practice Address - Street 1:2401 S FOOTHILL DR STE C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1479
Practice Address - Country:US
Practice Address - Phone:800-418-0730
Practice Address - Fax:801-505-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
UT9266865-17033336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140132OtherPK