Healthcare Provider Details

I. General information

NPI: 1073548699
Provider Name (Legal Business Name): COMMUNTIY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 3900 S STE 1H
SALT LAKE CITY UT
84124-1377
US

IV. Provider business mailing address

1220 E 3900 S STE 1H
SALT LAKE CITY UT
84124-1377
US

V. Phone/Fax

Practice location:
  • Phone: 801-270-0600
  • Fax: 801-270-0605
Mailing address:
  • Phone: 801-270-0600
  • Fax: 801-270-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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 Number3649031703
License Number StateUT

VIII. Authorized Official

Name: REED JENSEN
Title or Position: OWNER
Credential: B.S.
Phone: 801-270-0600