Healthcare Provider Details

I. General information

NPI: 1508119918
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 05/29/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7268 S BINGHAM JUNCTION BLVD
MIDVALE UT
84047-4860
US

IV. Provider business mailing address

PO BOX 30013
SALT LAKE CITY UT
84130-0013
US

V. Phone/Fax

Practice location:
  • Phone: 855-779-3960
  • Fax: 801-442-4179
Mailing address:
  • Phone: 855-779-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number8858671-1703
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NANNETTE MIGNON BERENSEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 801-507-8002