NPIMap

Organization Active NPI

Prime Therapeutics Pharmacy LLC

  • Mail Order Pharmacy
  • West Valley City, UT
National Provider Identifier
1356790364
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mail Order PharmacyTaxonomy code 3336M0002X
Legal business name
PRIME THERAPEUTICS PHARMACY LLC
Practice address
2256 S 3600 W Ste a
West Valley City, UT 84119-1124
Phone
(866) 554-2673
Fax
(866) 364-2673
NPI assigned
Jun 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Phi TranNPI 1346737954
Title
Pic
Phone
(855) 271-4810

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Mail Order Pharmacy 3336M0002X Primary
Specialty Pharmacy 3336S0011X 10303032-1704 UT

Addresses

Primary practice location

2256 S 3600 W Ste a
West Valley City, UT 84119-1124

Mailing address

2256 S 3600 W Ste a
West Valley City, UT 84119-1124
Phone (866) 554-2673

Other identifiers 2

IdentifierTypeStateIssuer
2162441OtherPK
4613560OtherNABP

Other names 1

  • Magellan Rx Pharmacy, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200519003140 UT DME Supplier - Pharmacy 5294930640 Practice locations: West Valley City, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Magellan RX Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6870 Shadowridge Dr
Ste 111
Orlando, FL 32812
Phone (407) 858-6326

2900 Ames Crossing Rd
Ste 200
Saint Paul, MN 55121
Phone (800) 858-0723

3175 23rd St
Ste 410
Astoria, NY 11106
Phone (718) 316-6814

2256 S 3600 W
West Valley City, UT 84119

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1356790364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2256 S 3600 W STE A",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841191124",
            "telephone_number": "866-554-2673",
            "fax_number": "866-364-2673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2256 S 3600 W STE A",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841191124",
            "telephone_number": "866-554-2673",
            "fax_number": "866-364-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME THERAPEUTICS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "PHI",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "855-271-4810"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "UT",
            "license": "10303032-1704",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162441",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4613560",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magellan Rx Pharmacy, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.