Provider Demographics
NPI:1457783201
Name:PHARMACARE, LLC
Entity Type:Organization
Organization Name:PHARMACARE, LLC
Other - Org Name:SUPER VALUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-302-0203
Mailing Address - Street 1:729 N REDWOOD RD
Mailing Address - Street 2:ATTN SUPER VALUE PHARMACY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-1909
Mailing Address - Country:US
Mailing Address - Phone:801-410-5000
Mailing Address - Fax:
Practice Address - Street 1:729 N REDWOOD RD
Practice Address - Street 2:ATTN SUPER VALUE PHARMACY
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-1909
Practice Address - Country:US
Practice Address - Phone:801-410-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8736072-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy