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NPI Code Detail

MEDICARE: IHC HEALTH SERVICES INC

MEDICARE: IHC HEALTH SERVICES 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
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy2901271703UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22100189OTHERPK

General Provider Information

NPI Number : 1588771299
Entity Type Code : Organization
Provider Name (Legal Business Name) : IHC HEALTH SERVICES INC
Provider Business Mailing Address
First Line : PO BOX 30013
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84130-0013
Country : US
Telephone Number : 801-779-6210
Fax Number :
Provider Business Practice Location Address
First Line : 2075 UNIVERSITY PARK BLVD
Second Line :
City : LAYTON
State : UT
Zip : 84041-1611
Country : US
Telephone Number : 801-779-6210
Fax Number : 801-779-6208
Authorized Official
Title or Position : VICE PRESIDENT OF CLINICAL SYSTEMS
Name : NANNETTE BERENSEN
Credential :
Telephone Number : 801-284-1005
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/19/2018

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Directions to “IHC HEALTH SERVICES INC ” Practice Location

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