| NPI | 1518148055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD WISE Pharmacy Coordinator 801-358-3365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WY R10141) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2018-04-26 |