Healthcare Provider Details

I. General information

NPI: 1114773132
Provider Name (Legal Business Name): HAVEN INTEGRATED PHARMACY OPERATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 S 3850 W STE 220
SALT LAKE CITY UT
84104-4939
US

IV. Provider business mailing address

1890 S 3850 W STE 220
SALT LAKE CITY UT
84104-4939
US

V. Phone/Fax

Practice location:
  • Phone: 385-549-1121
  • Fax: 855-571-3472
Mailing address:
  • Phone: 385-549-1121
  • Fax: 855-571-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4318030
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: DR. CHARLES OAXACA HALL
Title or Position: PRESIDENT AND PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 801-604-8736