| NPI | 1649401969 |
|---|---|
| Doing Business As | INTERMOUNTAIN SOUTHRIDGE PHARMACY |
| 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 7359499-1703) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2018-07-19 |