# IHC HEALTH SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IHC HEALTH SERVICES INC
- **Other names:** Intermountain Southridge Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649401969
- **Legal business name:** IHC HEALTH SERVICES INC
- **Authorized official:** NANNETTE BERENSEN (VICE PRESIDENT OF CLINICAL SYSTEMS)
- **Authorized official phone:** (801) 284-1005

## Contact information

- **Practice address:** 3723 W 12600 S STE 170, RIVERTON, UT 84065-7296
- **Practice address phone:** (801) 285-4500
- **Practice address fax:** (801) 285-4501
- **Mailing address:** PO BOX 30013, SALT LAKE CITY, UT 84130-0013
- **Mailing address phone:** (801) 285-4500
- **Mailing address fax:** (801) 442-3133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 7359499-1703 | UT | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/04/2009
- **Last updated:** 07/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1649401969 | — | ID |
| 05 | — | 1649401969 | — | UT |
| 05 | — | 1649401969 | — | WY |
| 01 | — | 2121208 | PK | — |