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Organization
FAMILY PLAZA PHARMACY INC
Active
Organization
FAMILY PLAZA PHARMACY INC
Active
Other names
FAMILY PLAZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE JENSEN PHARMD (OWNER)
(801) 569-0175
Entity
Organization
Contact information
Practice address
3570 W 9000 S, STE 150, WEST JORDAN, UT 84088-8869
(801) 569-0175
(801) 569-8941
Mailing address
3570 W 9000 S, STE 150, WEST JORDAN, UT 84088-8869
(801) 569-0175
(801) 569-6941
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
6732558-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099816
PK
—
Enumeration date
11/15/2005
Last updated
08/12/2016
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