Provider Demographics
NPI:1598766545
Name:F CRAIG HAZEN INC
Entity Type:Organization
Organization Name:F CRAIG HAZEN INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:F
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-399-1151
Mailing Address - Street 1:2562 MONROE BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2514
Mailing Address - Country:US
Mailing Address - Phone:801-399-1151
Mailing Address - Fax:801-399-1154
Practice Address - Street 1:2562 MONROE BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2514
Practice Address - Country:US
Practice Address - Phone:801-399-1151
Practice Address - Fax:801-399-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3272591703333600000X
UT3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870282481003Medicaid
UT4600474OtherNCPDP #
UTBT5115729OtherDEA #
UT4600474OtherNCPDP #
UT004444054Medicare PIN