Healthcare Provider Details

I. General information

NPI: 1508973215
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: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 S 1300 E
SANDY UT
84094-3762
US

IV. Provider business mailing address

PO BOX 30013
SALT LAKE CITY UT
84130-0013
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-2741
  • Fax: 801-501-2710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54204461703
License Number StateUT

VIII. Authorized Official

Name: DARRYL WAGNER
Title or Position: OUTPATIENT PHARMACY MANAGER
Credential:
Phone: 801-442-3903