Healthcare Provider Details

I. General information

NPI: 1922154756
Provider Name (Legal Business Name): GRANGER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 W 3500 S
WEST VALLEY CITY UT
84119-3602
US

IV. Provider business mailing address

2965 W 3500 S # W3500S
WEST VALLEY CITY UT
84119-3602
US

V. Phone/Fax

Practice location:
  • Phone: 801-965-3639
  • Fax: 801-965-9641
Mailing address:
  • Phone: 801-965-3639
  • Fax: 801-965-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number10310634-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10310634-1703
License Number StateUT

VIII. Authorized Official

Name: MR. BRYAN ALLRED
Title or Position: OWNER
Credential: PHARM. D.
Phone: 801-597-5650