MEDICARE: ENTERPRISE VALLEY MED CTR 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	6554473	UT
2	3336C0002X	Clinic Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4610691	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1649335761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERPRISE VALLEY MED CTR INC

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 SOUTH 200 EAST
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725
Country	:	US
Telephone Number	:	435-878-2281
Fax Number	:	435-878-2434

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CJ HANSEN
Credential	:	RPH
Telephone Number	:	435-878-2281

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	09/11/2025

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Directions to “ENTERPRISE VALLEY MED CTR INC ” Practice Location

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