Healthcare Provider Details

I. General information

NPI: 1457380131
Provider Name (Legal Business Name): SUPER SAVE MARKETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N STATE ST
OREM UT
84057-2029
US

IV. Provider business mailing address

1950 N STATE ST
OREM UT
84057-2029
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-3131
  • Fax: 801-229-2064
Mailing address:
  • Phone: 801-224-3131
  • Fax: 801-229-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number831273501703
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GARY STEVEN ALLEN
Title or Position: PRESIDENT
Credential:
Phone: 801-224-0999