Provider Demographics
NPI:1942728084
Name:CNS PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:CNS PROFESSIONAL SERVICES
Other - Org Name:CNS LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-886-0670
Mailing Address - Street 1:2820 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2375
Mailing Address - Country:US
Mailing Address - Phone:801-886-0670
Mailing Address - Fax:
Practice Address - Street 1:2820 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2375
Practice Address - Country:US
Practice Address - Phone:801-886-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CNS PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357198-17043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========055Medicaid