Healthcare Provider Details

I. General information

NPI: 1649335761
Provider Name (Legal Business Name): ENTERPRISE VALLEY MED CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 SOUTH 200 EAST
ENTERPRISE UT
84725
US

IV. Provider business mailing address

PO BOX 370
ENTERPRISE UT
84725-0370
US

V. Phone/Fax

Practice location:
  • Phone: 435-878-2281
  • Fax: 435-878-2434
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6554473
License Number StateUT

VIII. Authorized Official

Name: CJ HANSEN
Title or Position: EXECUTIVE DIRECTOR
Credential: RPH
Phone: 435-878-2281