Organization
UNIVERSITY OF UTAH
Active
Other names
RED BUTTE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KELLY (PHCY DIRECTOR)
(801) 587-6325
Entity
Organization
Contact information
Practice address
546 CHIPETA WAY, SALT LAKE CITY, UT 84108-1236
(801) 585-0544
(801) 585-0547
Mailing address
PO BOX 511124, SALT LAKE CITY, UT 84151-1124
(801) 587-6325
(801) 236-8043
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
58990601703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4609179
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/12/2006
Last updated
08/06/2009
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