NPIMap

Organization Active NPI

Maceys Inc

Doing business as Fresh Market Pharmacy #2367

  • Pharmacy
  • Taylorsville, UT
National Provider Identifier
1073847323
Registry record updated Feb 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
7442348-1703 Issued in UT
Legal business name
MACEYS INC
Doing business as
Maceys Inc. #1061
Practice address
1825 W 4700 S
Taylorsville, UT 84129-1103
Phone
(801) 964-2626
Fax
(801) 965-8005
NPI assigned
Sep 18, 2009
Last updated
Feb 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2021

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

Authorized official

Name
Shawna Kip Hanson
Title
Director of Pharmacy
Phone
(801) 978-8309

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 7442348-1703 UT Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1825 W 4700 S
Taylorsville, UT 84129-1103

Mailing address

PO Box 26908
Salt Lake City, UT 84126-0908
Phone (801) 978-8225

Other identifiers 2

IdentifierTypeStateIssuer
1073847323MedicaidUT
2121836OtherPK

Other names 2

  • Fresh Market Pharmacy #2367 Former legal business name
  • Maceys Inc. #1061 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080428000667 UT Part B Supplier - Mass Immunization (Roster Biller Only) 2466530688 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Provo, UT; West Valley City, UT; West Jordan, UT; Tooele, UT; Taylorsville, UT; Spanish Fork, UT; Sandy, UT; Salt Lake City, UT…
O20101203000620 UT Part B Supplier - Mass Immunization (Roster Biller Only) 9335336312 30 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; South Ogden, UT; American Fork, UT; Park City, UT; Ogden, UT; Layton, UT; Provo, UT

Other NPIs on the same Medicare enrollment 30

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 30

National Provider Directory

National Provider Directory
Tax ID family
Maceys Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1825 W 4700 S
Taylorsville, UT 84129
Phone (801) 964-2626

NPI Registry JSON

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

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613865600000",
    "number": "1073847323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26908",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841260908",
            "telephone_number": "801-978-8225",
            "fax_number": "801-978-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 W 4700 S",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841291103",
            "telephone_number": "801-964-2626",
            "fax_number": "801-965-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACEYS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-18",
        "last_updated": "2021-02-21",
        "certification_date": "2021-02-21",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_middle_name": "KIP",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "801-978-8309"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "UT",
            "license": "7442348-1703",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073847323",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121836",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Market Pharmacy #2367",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maceys Inc. #1061",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fresh Market Pharmacy #2367",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Taylorsville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.