Provider Demographics
NPI:1225026842
Name:GLADES HYLAND PHARMACIES
Entity Type:Organization
Organization Name:GLADES HYLAND PHARMACIES
Other - Org Name:APOTHECARY WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:KARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-969-1986
Mailing Address - Street 1:4188 WEST 5415 SOUTH
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4310
Mailing Address - Country:US
Mailing Address - Phone:801-969-1986
Mailing Address - Fax:801-982-1351
Practice Address - Street 1:4188 WEST 5415 SOUTH
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-4310
Practice Address - Country:US
Practice Address - Phone:801-969-1986
Practice Address - Fax:801-982-1351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLADES HYLAND PHARMACIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128825-1703333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4606438OtherNABP NUMBER
UT873075547002Medicaid
BA0144561OtherDEA NUMBER