Healthcare Provider Details

I. General information

NPI: 1205977162
Provider Name (Legal Business Name): WARREN RX ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 N 980 W
OREM UT
84057-7710
US

IV. Provider business mailing address

865 N 980 W
OREM UT
84057-7710
US

V. Phone/Fax

Practice location:
  • Phone: 801-735-2003
  • Fax: 801-225-2388
Mailing address:
  • Phone: 801-225-2150
  • Fax: 801-225-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7214363-1703
License Number StateUT

VIII. Authorized Official

Name: GARY NAKKEN
Title or Position: PRESIDENT
Credential:
Phone: 801-225-2150