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General NPI Number Information
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NPI Number | 1467549667
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Entity Type | Organization
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Legal Business Name | IHC HEALTH SERVICES INC
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 159 N MAIN ST
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City | MANTI
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State | UT
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Zip | 84642-1257
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Country | US
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Telephone | 435-835-4225
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Fax | 435-835-4227
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Provider Business Mailing Address
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Address Line | PO BOX 30013
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0013
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Country | US
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Telephone | 435-835-4225
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF CLINICAL SYSTEMS
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Name | NANNETTE BERENSEN
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Credential |
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Telephone | 801-284-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 61361651703
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License Number State | UT
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