Healthcare Provider Details

I. General information

NPI: 1174928949
Provider Name (Legal Business Name): MMCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 E 6200 S
HOLLADAY UT
84121-2268
US

IV. Provider business mailing address

2036 E 6200 S
HOLLADAY UT
84121-2268
US

V. Phone/Fax

Practice location:
  • Phone: 801-559-7719
  • Fax: 801-951-7189
Mailing address:
  • Phone: 801-559-7719
  • Fax: 801-951-7189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number91894241703
License Number StateUT

VIII. Authorized Official

Name: CHAD HAMMON
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 801-647-9587