NPIMap

Organization Active NPI

University of Utah

  • Community/Retail Pharmacy
  • Centerville, UT
National Provider Identifier
1104915792
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
62502141703 Issued in UT
Legal business name
UNIVERSITY OF UTAH
Practice address
26 S Main St
Ste 100
Centerville, UT 84014-1817
Phone
(801) 693-7950
Fax
(801) 693-7955
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Authorized official

Name
Kellee K Howell, CPHT
Title
Pharmacy Business Operation Manager
Phone
(801) 587-6334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 62502141703 UT Primary

Addresses

Primary practice location

26 S Main St
Ste 100
Centerville, UT 84014-1817

Mailing address

PO Box 841208
Los Angeles, CA 90084-1208
Phone (801) 587-6334

Other identifiers 2

IdentifierTypeStateIssuer
4610588OtherNCPDP
2100899OtherPK

Other names 1

  • CENTERVILLE PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201021001587 UT Part B Supplier - Mass Immunization (Roster Biller Only) 0749262665 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; Taylorsville, UT; Stansbury Park, UT; South Jordan, UT; Park City, UT; Orem, UT; Midvale, UT; Farmington, UT…

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Bruce D Etringer PHD54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

26 S Main St
Ste 100
Centerville, UT 84014
Phone (801) 693-7950

26 S Main St
Centerville, UT 84014
Phone (801) 693-7900

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1104915792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900841208",
            "telephone_number": "801-587-6334",
            "fax_number": "801-587-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 S MAIN ST",
            "address_2": "STE 100",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840141817",
            "telephone_number": "801-693-7950",
            "fax_number": "801-693-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A",
        "authorized_official_last_name": "HOWELL",
        "authorized_official_first_name": "KELLEE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHARMACY BUSINESS OPERATION MANAGER",
        "authorized_official_telephone_number": "801-587-6334",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "62502141703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4610588",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2100899",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTERVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CENTERVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.