Provider Demographics
NPI:1558374405
Name:HARMON CITY INC
Entity Type:Organization
Organization Name:HARMON CITY INC
Other - Org Name:HARMONS PHARMACY #88
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-957-8483
Mailing Address - Street 1:3540 S 4000 W
Mailing Address - Street 2:SUITE 430
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3260
Mailing Address - Country:US
Mailing Address - Phone:801-969-8261
Mailing Address - Fax:801-694-6923
Practice Address - Street 1:870 E 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4245
Practice Address - Country:US
Practice Address - Phone:801-714-4150
Practice Address - Fax:801-714-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357745-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========031Medicaid
UT=========031Medicaid