1023107612 NPI number — UNIVERSITY OF UTAH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023107612 NPI number — UNIVERSITY OF UTAH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF UTAH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARKWAY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023107612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-587-6334
Provider Business Mailing Address Fax Number:
801-587-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W 1300 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84058-7316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-234-8510
Provider Business Practice Location Address Fax Number:
801-234-8522
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWELL
Authorized Official First Name:
KELLEE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHARMACY BUSINESS OPERATION MANAGER
Authorized Official Telephone Number:
801-587-6334

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 3598331703 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4607478 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2099823 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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