| NPI | 1003251638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL CONTRERAS Billing 801-359-2256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (Licence: UT 8547079-1704) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2017-12-21 |