Provider Demographics
NPI:1316218449
Name:UTAH STATE HOSPITAL PHARMACY
Entity Type:Organization
Organization Name:UTAH STATE HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:EARNSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-344-4200
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84603-0270
Mailing Address - Country:US
Mailing Address - Phone:801-344-4601
Mailing Address - Fax:
Practice Address - Street 1:1300 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3554
Practice Address - Country:US
Practice Address - Phone:801-344-4601
Practice Address - Fax:801-344-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336I0012XSuppliersPharmacyInstitutional PharmacyGroup - Single Specialty