=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952748519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACEYS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 01/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 36TH ST
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84405-1673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-399-5866
-----------------------------------------------------
Fax | 801-621-4791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26417
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84126-0417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-978-8825
-----------------------------------------------------
Fax | 801-978-8634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MRS. SHAWNA K HANSON
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 801-978-8309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------