Provider Demographics
NPI:1922401256
Name:SP CARE LLC
Entity Type:Organization
Organization Name:SP CARE LLC
Other - Org Name:C3 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANGER/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:SCHNYEDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-553-3588
Mailing Address - Street 1:291 E 1400 S STE 4
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-703-2273
Mailing Address - Fax:435-703-2274
Practice Address - Street 1:291 E 1400 S STE 4
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-703-2273
Practice Address - Fax:435-703-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336M0003X, 3336S0011X
UT942624417043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147713OtherPK