Healthcare Provider Details

I. General information

NPI: 1649936238
Provider Name (Legal Business Name): KEARNEY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 03/09/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 NORTH MILL ROAD F-103
VINEYARD UT
84059
US

IV. Provider business mailing address

554 NORTH MILL ROAD F103
VINEYARD UT
84059-4005
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5820
  • Fax:
Mailing address:
  • Phone: 801-655-5820
  • Fax: 801-655-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER MORRIS KEARNEY
Title or Position: OWNER
Credential: RPH
Phone: 801-830-9366