Provider Demographics
NPI:1245459627
Name:MEDIPHARM
Entity type:Organization
Organization Name:MEDIPHARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-839-9079
Mailing Address - Street 1:PO BOX 71428
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0428
Mailing Address - Country:US
Mailing Address - Phone:801-733-9902
Mailing Address - Fax:801-733-9998
Practice Address - Street 1:1260 VINE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1700
Practice Address - Country:US
Practice Address - Phone:801-733-9902
Practice Address - Fax:801-733-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9680-07332B00000X
UT375923-1704332B00000X, 3336C0003X, 3336L0003X, 3336S0011X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy