NPIMap

Organization Active NPI

Associated Fresh Markets Inc

Doing business as Fresh Market Pharmacy #2356

  • Pharmacy
  • Ogden, UT
National Provider Identifier
1497088108
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
7442336-1703 Issued in UT
Legal business name
ASSOCIATED FRESH MARKETS INC
Doing business as
Fresh Market Pharmacy #2356
Practice address
3945 Washington Blvd
Ogden, UT 84403-1825
Phone
(801) 393-8680
Fax
(801) 334-6563
NPI assigned
Sep 13, 2009
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 Hanson, PHARMD
Title
Director, Pharmacy Operations
Phone
(801) 978-8309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 7442336-1703 UT Primary

Addresses

Primary practice location

3945 Washington Blvd
Ogden, UT 84403-1825

Mailing address

PO Box 26908
Salt Lake City, UT 84126-0908
Phone (801) 978-8225

Other identifiers 2

IdentifierTypeStateIssuer
1497088108MedicaidUT
4611528OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Fresh Market Pharmacy #2356 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 18

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

View all 18

National Provider Directory

National Provider Directory

Locations

3945 Washington Blvd
South Ogden, UT 84403
Phone (801) 393-8680

NPI Registry JSON

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

{
    "created_epoch": "1252800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569283200000",
    "number": "1497088108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26908",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841260908",
            "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": "3945 WASHINGTON BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844031825",
            "telephone_number": "801-393-8680",
            "fax_number": "801-334-6563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED FRESH MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-13",
        "last_updated": "2019-09-24",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "SHAWNA",
        "authorized_official_title_or_position": "DIRECTOR, PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "801-978-8309",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "UT",
            "license": "7442336-1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497088108",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4611528",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Market Pharmacy #2356",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fresh Market Pharmacy #2356",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogden, 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.