Healthcare Provider Details

I. General information

NPI: 1538105424
Provider Name (Legal Business Name): CRJ HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/14/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 CHAMBERS ST STE A
OGDEN UT
84403-5181
US

IV. Provider business mailing address

1028 CHAMBERS ST STE A
OGDEN UT
84403-5181
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0331
  • Fax: 855-273-1877
Mailing address:
  • Phone: 801-479-0331
  • Fax: 855-273-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48081501703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE R JACOBSON-WARE
Title or Position: OWNER
Credential: RPH
Phone: 801-479-0331