Provider Demographics
NPI:1457631798
Name:CARE FIRST PHARMACY - SOUTH
Entity Type:Organization
Organization Name:CARE FIRST PHARMACY - SOUTH
Other - Org Name:CARE FIRST PHARMACY SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIR. OF PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-853-2200
Mailing Address - Street 1:869 E 900 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-763-4160
Mailing Address - Fax:801-763-4158
Practice Address - Street 1:869 E 900 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-9132
Practice Address - Country:US
Practice Address - Phone:801-763-4160
Practice Address - Fax:801-763-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7994290-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4612087OtherNCPDP PROVIDER IDENTIFICATION NUMBER