Active NPI
Maceys Inc
- Community/Retail Pharmacy
- Provo, UT
National Provider Identifier
1083723217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 379792-1703
- Legal business name
- MACEYS INC
- Practice address
- 1402 N State St
Provo, UT 84604-2415 - Phone
- (801) 377-0307
- Fax
- (801) 377-3242
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shawna K Hanson
- Title
- Director of Pharmacy Operations
- Phone
- (801) 978-8309
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 379792-1703 | UT | Primary |
Addresses
Primary practice location
1402 N State St
Provo, UT 84604-2415
Mailing address
PO Box 26417
Salt Lake City, UT 84126-0417
Phone (801) 978-8225
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 870475597022 | Medicaid | UT |
Other names 1
- Macey's Pharmacy #3
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
Other NPIs on the same Medicare enrollment 16
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Provo, UT
- NPI 1437020534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1569283200000",
"number": "1083723217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26417",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841260417",
"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": "1402 N STATE ST",
"city": "PROVO",
"state": "UT",
"postal_code": "846042415",
"telephone_number": "801-377-0307",
"fax_number": "801-377-3242"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MACEYS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-30",
"last_updated": "2019-09-24",
"status": "A",
"authorized_official_last_name": "HANSON",
"authorized_official_first_name": "SHAWNA",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY OPERATIONS",
"authorized_official_telephone_number": "801-978-8309"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "UT",
"license": "379792-1703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "870475597022",
"state": "UT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Macey's Pharmacy #3",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Macey's Pharmacy #3",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; 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.