Provider Demographics
NPI:1053209825
Name:UNIVERSITY OF UTAH
Entity type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:801-587-6334
Mailing Address - Street 1:127 S 500 E STE 430A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1978
Mailing Address - Country:US
Mailing Address - Phone:801-587-6334
Mailing Address - Fax:801-587-2996
Practice Address - Street 1:243 E 6100 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7302
Practice Address - Country:US
Practice Address - Phone:801-587-6334
Practice Address - Fax:801-587-2996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT14209503-1704OtherUTAH PHARMACY - CLASS B LICENSE