Healthcare Provider Details

I. General information

NPI: 1396835229
Provider Name (Legal Business Name): UNIVERSITY OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

PO BOX 841208
LOS ANGELES CA
90084-1208
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3198
  • Fax: 801-587-3304
Mailing address:
  • Phone: 801-587-6334
  • Fax: 801-587-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number2728841705
License Number StateUT

VIII. Authorized Official

Name: KELLEE K HOWELL
Title or Position: PHARMACY BUSINESS OPERATIONS MGR
Credential: CPHT
Phone: 801-587-6334