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
—
—
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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