Healthcare Provider Details

I. General information

NPI: 1891700498
Provider Name (Legal Business Name): K AND A HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4658 HOLLADAY BLVD
SALT LAKE CITY UT
84117-5209
US

IV. Provider business mailing address

4658 HOLLADAY BLVD
SALT LAKE CITY UT
84117-5209
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-2696
  • Fax:
Mailing address:
  • Phone: 801-277-2696
  • Fax:

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 Number891318371703
License Number StateUT

VIII. Authorized Official

Name: KERRY BROWN
Title or Position: OWNER
Credential: RPH
Phone: 801-877-2696