Provider Demographics
NPI:1790147833
Name:UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:MIDVALLEY SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY BUSINESS OPERATIONS MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:801-587-6334
Mailing Address - Street 1:PO BOX 841208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-1208
Mailing Address - Country:US
Mailing Address - Phone:801-587-6334
Mailing Address - Fax:801-587-2996
Practice Address - Street 1:6056 S FASHION SQUARE DR STE 1000
Practice Address - Street 2:SUITE 1000
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5410
Practice Address - Country:US
Practice Address - Phone:801-213-8650
Practice Address - Fax:801-262-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X, 3336S0011X
UT973674317033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159504OtherPK
4613522OtherNCPDP