Provider Demographics
NPI:1972870517
Name:STATE OF UTAH
Entity Type:Organization
Organization Name:STATE OF UTAH
Other - Org Name:CHS USCF PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHS DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-522-7142
Mailing Address - Street 1:1480 N 8000 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116
Mailing Address - Country:US
Mailing Address - Phone:801-522-7142
Mailing Address - Fax:385-465-6186
Practice Address - Street 1:14425 BITTERBRUSH LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9501
Practice Address - Country:US
Practice Address - Phone:801-576-7116
Practice Address - Fax:801-576-7059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12287417043336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4612152OtherNCPDP PROVIDER IDENTIFICATION NUMBER