Provider Demographics
NPI:1396835229
Name:UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:UNIVERSITY OF UTAH HMHI OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY BUSINESS OPERATIONS MGR
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:PO BOX 841208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-1208
Mailing Address - Country:US
Mailing Address - Phone:801-587-6334
Mailing Address - Fax:801-587-2996
Practice Address - Street 1:501 CHIPETA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1222
Practice Address - Country:US
Practice Address - Phone:801-587-3198
Practice Address - Fax:801-587-3304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF UTAH PHARMACIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
UT27288417053336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4608406OtherNCPDP
UT870521827012Medicaid