Healthcare Provider Details

I. General information

NPI: 1376920629
Provider Name (Legal Business Name): UTAH VALLEY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E UNIVERSITY PKWY
OREM UT
84058-7601
US

IV. Provider business mailing address

214 E UNIVERSITY PKWY
OREM UT
84058-7601
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-3932
  • Fax: 801-224-3724
Mailing address:
  • Phone: 801-224-3932
  • Fax: 801-224-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number93789571703
License Number StateUT

VIII. Authorized Official

Name: DAVID GLENN
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 801-372-9600