MEDICARE: K AND A HOLDINGS

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	891318371703	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4606868	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891700498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K AND A HOLDINGS

Provider Business Mailing Address
First Line	:	4658 HOLLADAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5209
Country	:	US
Telephone Number	:	801-277-2696
Fax Number	:

Provider Business Practice Location Address
First Line	:	4658 HOLLADAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-5209
Country	:	US
Telephone Number	:	801-277-2696
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KERRY BROWN
Credential	:	RPH
Telephone Number	:	801-877-2696

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/27/2007

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Directions to “K AND A HOLDINGS ” Practice Location

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