| NPI | 1053575175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANNETTE BERENSEN Vice President Of Clinical Syst EMS 801-284-1005 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: UT 70157141703) |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| 333600000X Pharmacy | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2018-07-19 |