Provider Demographics
NPI:1083723217
Name:MACEYS INC
Entity Type:Organization
Organization Name:MACEYS INC
Other - Org Name:MACEY'S PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-978-8309
Mailing Address - Street 1:PO BOX 26417
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0417
Mailing Address - Country:US
Mailing Address - Phone:801-978-8225
Mailing Address - Fax:801-978-8634
Practice Address - Street 1:1402 N STATE ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2415
Practice Address - Country:US
Practice Address - Phone:801-377-0307
Practice Address - Fax:801-377-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT379792-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870475597022Medicaid
UT5314340007Medicare NSC