Provider Demographics
NPI:1932404126
Name:SENIOR CARE PHARMACY OF THE WEST LLC
Entity Type:Organization
Organization Name:SENIOR CARE PHARMACY OF THE WEST LLC
Other - Org Name:SENIOR CARE PHARMACY OF THE WEST, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAPATSARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-410-1980
Mailing Address - Street 1:380 W LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2915
Mailing Address - Country:US
Mailing Address - Phone:801-410-1980
Mailing Address - Fax:855-209-6825
Practice Address - Street 1:380 W LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2915
Practice Address - Country:US
Practice Address - Phone:801-410-1980
Practice Address - Fax:855-209-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT7819376-17043336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128503OtherPK