NPIMap

Organization Active NPI

Prime Therapeutics Pharmacy LLC

  • Mail Order Pharmacy
  • West Valley City, UT
National Provider Identifier
1609221647
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mail Order PharmacyTaxonomy code 3336M0002X
License
9771246-1703 Issued in UT
Legal business name
PRIME THERAPEUTICS PHARMACY LLC
Practice address
2256 S 3600 W Ste a
West Valley City, UT 84119-1124
Phone
(855) 271-4810
Fax
(888) 656-7762
NPI assigned
Apr 27, 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
Andrew Glover
Title
VP Pharmacy Operations
Phone
(612) 777-4940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mail Order Pharmacy 3336M0002X 9771246-1703 UT Primary

Addresses

Primary practice location

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

Mailing address

2256 S 3600 W Ste a
Salt Lake City, UT 84119-1124
Phone (855) 271-4810

Other names 1

  • Magellan Rx Pharmacy, LLC Former legal business name

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

2256 S 3600 W
Ste A
West Valley City, UT 84119
Phone (855) 271-4810

Practitioners & affiliated clinicians

Practitioners 1

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": "1461715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1609221647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2256 S 3600 W STE A",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841191124",
            "telephone_number": "855-271-4810"
        },
        {
            "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": "855-271-4810",
            "fax_number": "888-656-7762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME THERAPEUTICS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-27",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "612-777-4940"
    },
    "taxonomies": [
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "UT",
            "license": "9771246-1703",
            "primary": true
        }
    ],
    "identifiers": [],
    "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.