Healthcare Provider Details

I. General information

NPI: 1417066598
Provider Name (Legal Business Name): LIN'S SUPERMARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W SUNSET BLVD
SAINT GEORGE UT
84770-6587
US

IV. Provider business mailing address

PO BOX 26417
SLC UT
84126-0417
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-9781
  • Fax: 435-627-0404
Mailing address:
  • Phone: 801-978-8225
  • Fax: 801-978-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number369335-1703
License Number StateUT

VIII. Authorized Official

Name: SHAWNA K HANSON
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential:
Phone: 801-978-8309