Healthcare Provider Details

I. General information

NPI: 1043543754
Provider Name (Legal Business Name): ASSOCIATED FRESH MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2009
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 S 9TH E
SALT LAKE CITY UT
84105-2366
US

IV. Provider business mailing address

PO BOX 26908
SALT LAKE CITY UT
84126-0908
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-8742
  • Fax: 801-463-1153
Mailing address:
  • Phone: 801-978-8225
  • Fax: 801-978-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7439720-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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