CD Pharmacy LLC
Organization Active NPI Long Term Care Pharmacy · SLC, UT
NPI 1386980944 · NPPES record last updated Oct 29, 2024
Key facts
- NPI
- 1386980944
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- License
- 8627028-1704 (UT)
- Legal business name
- CD PHARMACY LLC
- Practice address
- 450 S 900 E Ste 150
SLC, UT 84102-2959 - Phone
- (801) 433-9500
- Fax
- (801) 433-9333
- NPI assigned
- Dec 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Kenneth Norris
- Title
- Owner
- Phone
- (801) 433-9500
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 5
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D2192873 | CD Pharmacy LLC | Certificate of waiver | Sep 14, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Red Rock Pharmacy |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140424002244 | UT | Part B Supplier - Pharmacy | 0143453241 | Practice locations: Salt Lake City, UT |
| O20201001001468 | UT | Part B Supplier - Independent Clinical Laboratory | 0143453241 | Practice locations: Salt Lake City, UT |
| O20220322000735 | UT | DME Supplier - Pharmacy | 0143453241 | Practice locations: Salt Lake City, UT |
National Provider Directory
- Tax ID family
- CD Pharmacy LLC
Locations
2710 S Roosevelt St
Tempe, AZ 85282
Phone (480) 687-3540
450 S 900 E
Ste 1
Salt Lake City, UT 84102
Phone (801) 433-9500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | 8627028-1704 | UT | Yes |
| Managed Care Organization Pharmacy | 3336M0003X |
Addresses
Primary practice location
450 S 900 E Ste 150
SLC, UT 84102-2959
Mailing address
450 S 900 E
Ste 150
SLC, UT 84102-2981
Phone (801) 433-9500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2139564 | Other | PK |
Other names
- Red Rock Pharmacy
Other providers in SLC, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.