Provider Demographics
NPI:1700107604
Name:PRECISION MEDICAL PHARMACY, LLC
Entity Type:Organization
Organization Name:PRECISION MEDICAL PHARMACY, LLC
Other - Org Name:WESTLAKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-221-9355
Mailing Address - Street 1:270 E CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-2966
Mailing Address - Country:US
Mailing Address - Phone:801-221-9355
Mailing Address - Fax:801-221-3706
Practice Address - Street 1:270 E CROSSROADS BLVD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-2966
Practice Address - Country:US
Practice Address - Phone:801-221-9355
Practice Address - Fax:801-221-3706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8615548-1703333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4611910OtherNCPDP
2139979OtherPK