NPIMap

Organization Active NPI

University of Utah

Doing business as South Jordan Pharmacy

  • Community/Retail Pharmacy
  • South Jordan, UT
National Provider Identifier
1578652160
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
81397451703 Issued in UT
Legal business name
UNIVERSITY OF UTAH
Doing business as
South Jordan Pharmacy
Practice address
5126 W Daybreak Pkwy
Room 101
South Jordan, UT 84009-5994
Phone
(801) 213-4550
Fax
(801) 213-4555
NPI assigned
Oct 12, 2006
Last updated
Mar 16, 2021By the provider in NPPES
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 Operations Manage
Phone
(801) 587-6334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 81397451703 UT Primary

Addresses

Primary practice location

5126 W Daybreak Pkwy
Room 101
South Jordan, UT 84009-5994

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2100755OtherPK
4609561OtherNCPDP

Other names 1

  • SOUTH JORDAN 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
Division of Artificial54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

5126 W Daybreak Pkwy
Rm 101
South Jordan, UT 84009
Phone (801) 213-4550

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": "1578652160",
    "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": "5126 W DAYBREAK PKWY",
            "address_2": "ROOM 101",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840095994",
            "telephone_number": "801-213-4550",
            "fax_number": "801-213-4555"
        }
    ],
    "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "81397451703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2100755",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4609561",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH JORDAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH JORDAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Jordan, 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.