MEDICARE: ASSOCIATED FRESH MARKETS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	7439720-1703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2121837	OTHER		PK

General Provider Information

NPI Number	:	1043543754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED FRESH MARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 26908
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84126-0908
Country	:	US
Telephone Number	:	801-978-8225
Fax Number	:	801-978-8634

Provider Business Practice Location Address
First Line	:	1638 S 9TH E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2366
Country	:	US
Telephone Number	:	801-484-8742
Fax Number	:	801-463-1153

Authorized Official
Title or Position	:	DIRECTOR, PHARMACY OPERATIONS
Name	:	SHAWNA HANSON
Credential	:	PHARMD
Telephone Number	:	801-978-8309

Provider Enumeration Date	:	09/13/2009
Last Update Date	:	02/24/2025

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Directions to “ASSOCIATED FRESH MARKETS INC ” Practice Location

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