1164695318 NPI number — UNIVERSITY OF UTAH PHARMACIES

Table of content: (NPI 1164695318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164695318 NPI number — UNIVERSITY OF UTAH PHARMACIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF UTAH PHARMACIES
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:
Provider Other Organization Name Type Code:
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:
1164695318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2021
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:
250 E 200 S STE 1325
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84111-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-587-6334
Provider Business Practice Location Address Fax Number:
801-587-2996
Provider Enumeration Date:
04/09/2008

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 OPERATIONS MGR
Authorized Official Telephone Number:
801-587-6334

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 744 . This is a "NCPDP CHAIN CODE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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