Provider Demographics
NPI:1689238479
Name:PIONEER DRUG LLC
Entity type:Organization
Organization Name:PIONEER DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-882-7775
Mailing Address - Street 1:4776 AUTUMN CV
Mailing Address - Street 2:
Mailing Address - City:ERDA
Mailing Address - State:UT
Mailing Address - Zip Code:84074-5548
Mailing Address - Country:US
Mailing Address - Phone:435-882-7775
Mailing Address - Fax:
Practice Address - Street 1:3435 E PONY EXPRESS PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005
Practice Address - Country:US
Practice Address - Phone:801-753-5100
Practice Address - Fax:801-753-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689238479OtherMEDICARE
UT1689238479Medicaid