Provider Demographics
NPI:1538105424
Name:CRJ HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CRJ HEALTH SERVICES, INC
Other - Org Name:WASATCH PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBSON-WARE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-479-0331
Mailing Address - Street 1:1028 CHAMBERS ST STE A
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5181
Mailing Address - Country:US
Mailing Address - Phone:801-479-0331
Mailing Address - Fax:855-273-1877
Practice Address - Street 1:1028 CHAMBERS ST STE A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5181
Practice Address - Country:US
Practice Address - Phone:801-479-0331
Practice Address - Fax:855-273-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
UT480815017033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4693342OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4693342OtherNCPDP PROVIDER IDENTIFICATION NUMBER