Healthcare Provider Details

I. General information

NPI: 1598766545
Provider Name (Legal Business Name): F CRAIG HAZEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2562 MONROE BLVD
OGDEN UT
84401-2514
US

IV. Provider business mailing address

2562 MONROE BLVD
OGDEN UT
84401-2514
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1151
  • Fax: 801-399-1154
Mailing address:
  • Phone: 801-399-1151
  • Fax: 801-399-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3272591703
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateUT

VIII. Authorized Official

Name: F CRAIG HAZEN
Title or Position: OWNER/PRESIDENT
Credential: RPH
Phone: 801-399-1151