Provider Demographics
NPI:1437573649
Name:COLD FRONT PHARMACY
Entity type:Organization
Organization Name:COLD FRONT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-350-1674
Mailing Address - Street 1:339 E 3900 S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1677
Mailing Address - Country:US
Mailing Address - Phone:801-350-1674
Mailing Address - Fax:
Practice Address - Street 1:339 E 3900 S
Practice Address - Street 2:SUITE 150
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1677
Practice Address - Country:US
Practice Address - Phone:801-350-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy