Provider Demographics
NPI:1992098271
Name:EZ MED LLC
Entity type:Organization
Organization Name:EZ MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF EZ MED LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-856-8462
Mailing Address - Street 1:450 S 400 E STE 70
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4938
Mailing Address - Country:US
Mailing Address - Phone:801-856-8462
Mailing Address - Fax:
Practice Address - Street 1:450 S 400 E STE 70
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4938
Practice Address - Country:US
Practice Address - Phone:801-397-5900
Practice Address - Fax:801-397-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7303458-17043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy