Healthcare Provider Details

I. General information

NPI: 1326371584
Provider Name (Legal Business Name): MACEYS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 S HIGHLAND DR
SALT LAKE CITY UT
84117-4202
US

IV. Provider business mailing address

1850 W 2100 S ATTN PHARMACY DEPARTMENT
SALT LAKE CITY UT
84119-1304
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-5388
  • Fax: 801-278-1206
Mailing address:
  • Phone: 801-978-8225
  • Fax: 801-978-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7442364-1703
License Number StateUT

VIII. Authorized Official

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