NPIMap

University of Utah

Organization Active NPI Community/Retail Pharmacy · Salt Lake City, UT

NPI 1114016706 · NPPES record last updated Mar 16, 2021

Key facts

NPI
1114016706
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
7098434-1703 (UT)
Legal business name
UNIVERSITY OF UTAH
Practice address
1525 W 2100 S
Salt Lake City, UT 84119-1407
Phone
(801) 213-9950
Fax
(801) 213-9965
NPI assigned
Oct 12, 2006
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 17

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in UT

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University of Utah Hospitals and Clinics
Salt Lake City, UT · CCN 460009		 Hospital 5% Or Greater Direct Ownership Interest Jun 17, 1966
University of Utah
Salt Lake City, UT · CCN 46T009		 Hospital 5% Or Greater Direct Ownership Interest Jun 17, 1966

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930043425 UT DME Supplier - Pharmacy 0749262665 Practice locations: Salt Lake City, UT
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…

National Provider Directory

Tax ID family
Bruce D Etringer PHD (54 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 7098434-1703 UT Yes

Addresses

Primary practice location

1525 W 2100 S
Salt Lake City, UT 84119-1407

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
4606236OtherNCPDP
2108200OtherPK

Other names

  • REDWOOD PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 16, 2021.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615852800000",
    "number": "1114016706",
    "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": "1525 W 2100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841191407",
            "telephone_number": "801-213-9950",
            "fax_number": "801-213-9965"
        }
    ],
    "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 OPERATIONS MANAGE",
        "authorized_official_telephone_number": "801-587-6334",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "7098434-1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4606236",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2108200",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REDWOOD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "REDWOOD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

All providers in Salt Lake City, UT · Community/Retail Pharmacy in Utah

Sources for this page

Verify at the official NPI Registry.