| NPI | 1902074792 |
|---|---|
| Doing Business As | INTERMOUNTAIN NORTH OREM PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DARRYL WAGNER Out PT Phcy Mang 801-442-3903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0002X Pharmacy Clinic Pharmacy (Licence: UT 67524041703) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-19 |