Provider Demographics
NPI:1023158342
Name:RICE FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:RICE FAMILY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMESON
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-485-9281
Mailing Address - Street 1:4624 S. HOLLADAY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-485-9281
Mailing Address - Fax:801-486-8170
Practice Address - Street 1:4624 S. HOLLADAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-485-9281
Practice Address - Fax:801-486-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT5602774-17033336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870255023001Medicaid