MEDICARE: UTAH NAVAJO HEALTH SYSTEM INCORPORATED

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	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy	10646843-1703	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	2122751	OTHER	PK

General Provider Information

NPI Number	:	1538496153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH NAVAJO HEALTH SYSTEM INCORPORATED

Provider Business Mailing Address
First Line	:	30 WEST MEDICAL DRIVE
Second Line	:
City	:	MONUMENT VALLEY
State	:	UT
Zip	:	84536
Country	:	US
Telephone Number	:	435-727-3018
Fax Number	:	435-727-3082

Provider Business Practice Location Address
First Line	:	30 WEST MEDICAL DRIVE
Second Line	:
City	:	MONUMENT VALLEY
State	:	UT
Zip	:	84536
Country	:	US
Telephone Number	:	435-727-3018
Fax Number	:	435-727-3082

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	CHAD MOSES
Credential	:	PHARMD
Telephone Number	:	435-678-4640

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	05/04/2018

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Directions to “UTAH NAVAJO HEALTH SYSTEM INCORPORATED ” Practice Location

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