Organization
IHC HEALTH SERVICES INC
Active
Other names
INTERMOUNTAIN NORTH OREM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL WAGNER RPH (OUTPT PHCY MANG)
(801) 442-3903
Entity
Organization
Contact information
Practice address
1975 N STATE ST, OREM, UT 84057-2028
(801) 714-5500
(801) 714-5511
Mailing address
PO BOX 30013, SALT LAKE CITY, UT 84130-0013
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
67524041703
UT
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4610932
OTHER ID NUMBER
—
Enumeration date
02/14/2008
Last updated
02/19/2008
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