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General NPI Number Information
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NPI Number | 1790892404
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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 | 08/25/2006
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 100 N MARIO CAPECCHI DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84113-1103
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Country | US
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Telephone | 801-662-1680
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Fax | 801-662-1688
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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 |
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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 | 801-507-8002
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 49062421703
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License Number State | UT
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