Healthcare Provider Details

I. General information

NPI: 1487743076
Provider Name (Legal Business Name): UNIVERSITY OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CENTRAL CAMPUS DR ROOM 156
SALT LAKE CITY UT
84112-9149
US

IV. Provider business mailing address

PO BOX 511124
SALT LAKE CITY UT
84151-1124
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3363
  • Fax: 801-236-8043
Mailing address:
  • Phone: 801-587-6325
  • Fax: 801-236-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number57847791703
License Number StateUT

VIII. Authorized Official

Name: MICHAEL KELLY
Title or Position: PHARMACY ADMINISTRATOR
Credential:
Phone: 801-587-6325