Provider Demographics
NPI:1538496153
Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Entity Type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-678-4640
Mailing Address - Street 1:30 WEST MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONUMENT VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84536
Mailing Address - Country:US
Mailing Address - Phone:435-727-3018
Mailing Address - Fax:435-727-3082
Practice Address - Street 1:30 WEST MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:MONUMENT VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84536
Practice Address - Country:US
Practice Address - Phone:435-727-3018
Practice Address - Fax:435-727-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
UT10646843-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1538496153Medicaid
AZ655047Medicaid
2122751OtherPK