| De Novo Services Llc | |
|
339 E 3900 S Suite 155 Salt Lake City UT 84107-1677 | |
| (801) 263-1056 | |
| (801) 261-3701 |
| Full Name | De Novo Services Llc |
|---|---|
| Speciality | Pharmacy |
| Location | 339 E 3900 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Jerry Costley (DIRECTOR / OWNER) |
| Authorized Official Contact | 8012631056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| De Novo Services Llc 339 E 3900 S Suite 155 Salt Lake City UT 84107-1677 Ph: (801) 263-1056 | De Novo Services Llc 339 E 3900 S Suite 155 Salt Lake City UT 84107-1677 Ph: (801) 263-1056 |
| NPI Number | 1164794434 |
|---|---|
| Provider Enumeration Date | 02/02/2012 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Medicare PECOS PAC ID | 4183961279 |
|---|---|
| Medicare Enrollment ID | O20200218002918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164794434 | NPI | - | NPPES |
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