Provider Demographics
NPI:1821097221
Name:HEALTHWISE PHARMACY, INC.
Entity Type:Organization
Organization Name:HEALTHWISE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-489-7300
Mailing Address - Street 1:403B S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2252
Mailing Address - Country:US
Mailing Address - Phone:801-489-7300
Mailing Address - Fax:801-489-4949
Practice Address - Street 1:403B S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2252
Practice Address - Country:US
Practice Address - Phone:801-489-7300
Practice Address - Fax:801-489-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BN1400X
UT55310661704333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid