| NPI | 1336692516 |
|---|---|
| Doing Business As | INTERMOUNTAIN PHARMACY #136 |
| Entity Type | Organization |
| Authorized Contact | NANNETTE BERENSEN Vice President Of Clinical Systems 801-284-1005 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: UT 9867311-1703) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2018-07-19 |