| NPI | 1053075374 |
|---|---|
| Doing Business As | INTERMOUNTAIN PHARMACY #21 |
| Other Name | INTERMOUNTAIN HEALTH CANDELAS PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RONALD SPARKS VP Ancillary & Support Operations 303-813-5187 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2021-10-22 |
| Last Update Date | 2023-11-07 |