Provider Demographics
NPI:1912341256
Name:UHS OF PROVO CANYON INC
Entity Type:Organization
Organization Name:UHS OF PROVO CANYON INC
Other - Org Name:PROVO CANYON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-852-3859
Mailing Address - Street 1:1350 E 750 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4345
Mailing Address - Country:US
Mailing Address - Phone:801-852-3859
Mailing Address - Fax:801-227-2199
Practice Address - Street 1:1350 E 750 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4345
Practice Address - Country:US
Practice Address - Phone:801-852-3859
Practice Address - Fax:801-227-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT834283317043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139426OtherPK