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General NPI Number Information
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NPI Number | 1609734243
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Entity Type | Organization
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Legal Business Name | CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1882 W INDIANA AVE STE 30
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-3688
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Country | US
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Telephone | 801-359-2256
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Fax |
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Provider Business Mailing Address
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Address Line | 1882 W INDIANA AVE STE 30
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-3688
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Country | US
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Telephone | 801-359-2256
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Fax |
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | JOSH W ANDERSON
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Credential |
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Telephone | 801-359-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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