Organization
DIABETES SPECIALTY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM E DOMAN (CONTROLLER)
(801) 263-5442
Entity
Organization
Contact information
Practice address
3744 SECOND STREET, STE A, SALT LAKE CITY, UT 84115
(801) 268-9699
(888) 321-7719
Mailing address
3793 SOUTH STATE STREET, SALT LAKE CITY, UT 84115-4828
(801) 268-9699
(801) 268-9929
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
5738699-1703
UT
333600000X
Pharmacy
Primary
8021342-1703
UT
3336C0003X
Community/Retail Pharmacy
5738699-1703
UT
Other
Enumeration date
01/19/2006
Last updated
03/07/2023
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