NPIMap

Organization Active NPI

Macey's Inc

  • Community/Retail Pharmacy
  • Draper, UT
National Provider Identifier
1386963593
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MACEY'S INC
Practice address
1212 E Draper Pkwy
Draper, UT 84020-9097
Phone
(801) 571-1406
Fax
(801) 571-1085
NPI assigned
May 27, 2010
Last updated
Jan 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2019

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 1

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

Addresses

Primary practice location

1212 E Draper Pkwy
Draper, UT 84020-9097

Mailing address

1850 W 2100 S
Salt Lake City, UT 84119-1304
Phone (801) 978-8699

Other identifiers 2

IdentifierTypeStateIssuer
1386963593MedicaidUT
2125301OtherPK

Other names 1

  • Macey's Pharmacy #1064 Other name

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2018018Macey's Inc #10641212 Draper Parkway, Draper, UT 84020Certificate of waiverDec 21, 2026

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.

Practitioners & affiliated clinicians

Practitioners 1

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": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1386963593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 W 2100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841191304",
            "telephone_number": "801-978-8699",
            "fax_number": "801-978-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 E DRAPER PKWY",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209097",
            "telephone_number": "801-571-1406",
            "fax_number": "801-571-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACEY'S INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2019-01-16",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386963593",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125301",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macey's Pharmacy #1064",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Draper, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.