MEDICARE: IHC HEALTH SERVICES INC

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	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	3336M0002X	Mail Order Pharmacy	8858671-1703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2137364	OTHER	PK

General Provider Information

NPI Number	:	1508119918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHC HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 30013
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0013
Country	:	US
Telephone Number	:	855-779-3960
Fax Number	:

Provider Business Practice Location Address
First Line	:	7268 S BINGHAM JUNCTION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4860
Country	:	US
Telephone Number	:	855-779-3960
Fax Number	:	801-442-4179

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	NANNETTE MIGNON BERENSEN
Credential	:
Telephone Number	:	801-507-8002

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	05/29/2024

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Directions to “IHC HEALTH SERVICES INC ” Practice Location

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