Healthcare Provider Details

I. General information

NPI: 1174131916
Provider Name (Legal Business Name): HEARTLAND PHARMACY - UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CUTLER DR
NORTH SALT LAKE UT
84054-2966
US

IV. Provider business mailing address

1790 SABIN DR
AMMON ID
83406-6747
US

V. Phone/Fax

Practice location:
  • Phone: 208-497-3575
  • Fax:
Mailing address:
  • Phone: 208-497-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: REECE CHRISTENSEN
Title or Position: CEO PRESIDENT
Credential:
Phone: 208-497-3575