Organization
IHC HEALTH SERVICES INC
Active
Other names
Intermountain Pharmacy #128
Organization subpart
No
Provider details
NPI number
Authorized official
NANNETTE BERENSEN (VP COO SHARED CLINICAL SERVICES)
(801) 507-8002
Entity
Organization
Contact information
Practice address
8TH AVE AND C ST, SALT LAKE CITY, UT 84143-0001
(801) 408-1019
(801) 408-5172
Mailing address
PO BOX 30013, SALT LAKE CITY, UT 84130-0013
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982711693
—
ID
05
—
1982711693
—
NV
05
—
1982711693
—
UT
01
—
2107617
PK
—
Enumeration date
08/25/2006
Last updated
01/24/2022
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