NPIMap

Organization Active NPI

Maceys Inc

  • Community/Retail Pharmacy
  • West Valley City, UT
National Provider Identifier
1700119013
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MACEYS INC
Practice address
3555 W 3500 S
West Valley City, UT 84119-2539
Phone
(801) 963-6874
Fax
(801) 965-9953
NPI assigned
Sep 18, 2009
Last updated
Jun 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

3555 W 3500 S
West Valley City, UT 84119-2539

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2121986OtherPK
1700119013MedicaidUT

Other names 1

  • Macey's Inc. #1068 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
46D1031915Macey's #10683555 W 3500 S, West Valley City, UT 84119Certificate 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.

Locations

3555 W 3500 S
West Valley City, UT 84119
Phone (801) 963-6874

NPI Registry JSON

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

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1700119013",
    "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": "3555 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841192539",
            "telephone_number": "801-963-6874",
            "fax_number": "801-965-9953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACEYS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-18",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121986",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700119013",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macey's Inc. #1068",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.