Organization
UTAH STATE DEVELOPMENTAL CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK WHITNEY RP (PHARMACY DIRECTOR)
(801) 763-4160
Entity
Organization
Contact information
Practice address
895 N 900 E, AMERICAN FORK, UT 84003-9183
(801) 763-4036
(801) 763-4073
Mailing address
895 N 900 E, AMERICAN FORK, UT 84003-9183
(801) 763-4036
(801) 763-4073
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
122434-1704
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4603773
NCPDP
UT
01
—
52820957000001
BLUE CROSS
UT
05
—
876000545015
—
UT
Enumeration date
08/14/2006
Last updated
08/22/2020
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