MEDICARE: UNIVERSITY OF UTAH

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	3598341703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2099824	OTHER		PK

General Provider Information

NPI Number	:	1336239318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF UTAH

Provider Business Mailing Address
First Line	:	PO BOX 841208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-1208
Country	:	US
Telephone Number	:	801-587-6334
Fax Number	:	801-587-2996

Provider Business Practice Location Address
First Line	:	3730 W 4700 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84118-3457
Country	:	US
Telephone Number	:	801-213-9250
Fax Number	:	801-213-9255

Authorized Official
Title or Position	:	PHARMACY BUSINESS OPERATIONS MANAGE
Name	:	KELLEE K HOWELL
Credential	:	CPHT
Telephone Number	:	801-587-6334

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/16/2021

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Directions to “UNIVERSITY OF UTAH ” Practice Location

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