Healthcare Provider Details

I. General information

NPI: 1871514844
Provider Name (Legal Business Name): CLEARFIELD JOB CORPS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 1700 S
CLEARFIELD UT
84016-6004
US

IV. Provider business mailing address

PO BOX 160070
CLEARFIELD UT
84016-0070
US

V. Phone/Fax

Practice location:
  • Phone: 801-416-4467
  • Fax: 801-416-4636
Mailing address:
  • Phone: 801-416-4467
  • Fax: 801-416-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number1268151704
License Number StateUT

VIII. Authorized Official

Name: LORI HENRY
Title or Position: WELLNESS ADMINISTRATOR
Credential: RM
Phone: 801-416-4628