| NPI | 1861084949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCHELLE JONES Credentialing Supervisor 801-475-3481 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-02-16 |