=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013354067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCKAY-DEE HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2013
-----------------------------------------------------
Last Update Date | 05/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4401 HARRISON BLVD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-3195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-387-6002
-----------------------------------------------------
Fax | 801-387-6022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 HARRISON BLVD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-3195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-387-6002
-----------------------------------------------------
Fax | 801-387-6022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOP
-----------------------------------------------------
Name | TERRIE KOEHLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-387-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | 5054334-1704
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------