Provider Demographics
NPI:1316994015
Name:UNIVERSITY PHARMACY INC.
Entity type:Organization
Organization Name:UNIVERSITY PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:RASMUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-582-7624
Mailing Address - Street 1:1320 E 200 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2604
Mailing Address - Country:US
Mailing Address - Phone:801-582-7624
Mailing Address - Fax:801-582-7633
Practice Address - Street 1:1320 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2604
Practice Address - Country:US
Practice Address - Phone:801-582-7624
Practice Address - Fax:801-582-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2212407017033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000072095OtherPTAN FOR PART B
UT870328034005Medicaid
UTU000072095OtherPTAN FOR PART B