Provider Demographics
NPI:1639127079
Name:CNS PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:CNS PROFESSIONAL SERVICES
Other - Org Name:CNS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-233-6100
Mailing Address - Street 1:3685 W 6200 S STE C
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3731
Mailing Address - Country:US
Mailing Address - Phone:801-233-6120
Mailing Address - Fax:801-233-6139
Practice Address - Street 1:3685 W 6200 S STE C
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3731
Practice Address - Country:US
Practice Address - Phone:801-233-6120
Practice Address - Fax:801-233-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT88941231704251F00000X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========038Medicaid
UT0611610001Medicare NSC