Healthcare Provider Details

I. General information

NPI: 1790892404
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/21/2024
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 30013
SALT LAKE CITY UT
84130-0013
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1680
  • Fax: 801-662-1688
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number49062421703
License Number StateUT

VIII. Authorized Official

Name: NANNETTE BERENSEN
Title or Position: VICE PRESIDENT OF CLINICAL SYSTEMS
Credential:
Phone: 801-507-8002