NPIMap

Organization Active NPI

Maceys Inc

Doing business as Macey's Pharmacy #5

  • Community/Retail Pharmacy
  • Tooele, UT
National Provider Identifier
1275642415
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4551508-1703 Issued in UT
Legal business name
MACEYS INC
Doing business as
Macey's Pharmacy #5
Practice address
972 N Main St
Tooele, UT 84074-1616
Phone
(435) 843-8821
Fax
(435) 843-0254
NPI assigned
Aug 30, 2006
Last updated
Sep 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

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)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 4551508-1703 UT Primary

Addresses

Primary practice location

972 N Main St
Tooele, UT 84074-1616

Mailing address

PO Box 26417
SLC, UT 84126-0417
Phone (801) 978-8225

Other names 1

  • Macey's Pharmacy #5 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080428000667 UT Part B Supplier - Mass Immunization (Roster Biller Only) 2466530688 16 other NPIs on this 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.

View all 16

National Provider Directory

National Provider Directory

Locations

972 N Main St
Tooele, UT 84074
Phone (435) 843-8821

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1275642415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26417",
            "city": "SLC",
            "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": "972 N MAIN ST",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741616",
            "telephone_number": "435-843-8821",
            "fax_number": "435-843-0254"
        }
    ],
    "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": "4551508-1703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macey's Pharmacy #5",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Macey's Pharmacy #5",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tooele, 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.

Verify at the official NPI Registry.