| NPI | 1487743076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KELLY Pharmacy Administrator 801-587-6325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: UT 57847791703) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2009-08-06 |