MEDICARE: IMA-SLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist

General Provider Information

NPI Number	:	1285482174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMA-SLC

Provider Business Mailing Address
First Line	:	95 S STATE ST STE 1300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1659
Country	:	US
Telephone Number	:	801-644-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 S STATE ST STE 1300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1659
Country	:	US
Telephone Number	:	801-325-5097
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DR. AUSTIN NABOR
Credential	:	PHARM.D
Telephone Number	:	801-325-5097

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “IMA-SLC ” Practice Location

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