Fusion Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

FUSION PHARMACY LLC

Practice address

617 E Riverside Dr Ste 104
St George, UT 84790

Phone

(435) 703-9680

NPI assigned

Nov 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Koby Taylor, PHARMDNPI 1154457380

Title

Owner

Phone

(435) 656-2059

Specialties & licenses 1

Addresses

Other names 1

• Fusion Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Koby Taylor, PHARM.D., R.PH.

  • Pharmacist
  • Santa Clara, UT
  • NPI 1154457380
  NPD Authorized official
• Travis Snow, PHARMD

  • Pharmacist
  • Santa Clara, UT
  • NPI 1124533377
  NPD
• Makinna Clough

  • Pharmacy Technician
  • St George, UT
  • NPI 1316537913
  NPD (past)
• Travis C Jackman, PHARM D

  • Pharmacist
  • St George, UT
  • NPI 1144595968
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1114439775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 CANYON VIEW DR STE C",
            "city": "SANTA CLARA",
            "state": "UT",
            "postal_code": "847655672",
            "telephone_number": "435-703-9680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E RIVERSIDE DR STE 104",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "84790",
            "telephone_number": "435-703-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUSION PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-03",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KOBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-656-2059",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fusion Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mickey Joe Fuller, MA, MS, PSY.D.
• Baylee Fullmer
• Alexis Marie Fulton
• Kimberely Funk
• Brittani Furnival
• G. Paul Doxey, M.D., P.C.
• Kimberly Gabriel
• Kayla Gabrielson
• Fernando Cavalcante Gade
• Aaya Gahelrasool

• Pharmacy in St George, UT
• Providers in St George, UT by specialty
• Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.