Blue Sparrow Wellness Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

5725931-1701 Issued in UT

Legal business name

BLUE SPARROW WELLNESS PHARMACY

Practice address

558 E Riverside Dr Ste 104
St George, UT 84790-7176

Phone

(435) 674-0201

Fax

(435) 674-0217

NPI assigned

Jun 30, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Cody Kim Hansen, PHARMACIST

Title

Owner/Pharmacist in Charge

Phone

(435) 674-0201

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033630918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 E RIVERSIDE DR STE 104",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907176",
            "telephone_number": "435-674-0201",
            "fax_number": "435-674-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 E RIVERSIDE DR STE 104",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907176",
            "telephone_number": "435-674-0201",
            "fax_number": "435-674-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SPARROW WELLNESS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "CODY",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "OWNER/PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "435-674-0201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "UT",
            "license": "5725931-1701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in St George, UT
• Providers in St George, UT by specialty
• Pharmacist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.