National Provider Identifier Database

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
3448 S 3200 W
WEST VALLEY CITY, UT84119-2628
Phone: 801-359-2256
Fax:
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION

NPI Number 1790370955
Legal business name
LBN
CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
Authorized official CRYSTAL CONTRERAS - (BILLING MANAGER)
Entity Organization
Organization subpart No
Enumeration date 03/09/2021
Last updated 03/09/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • UT Other: 119950086-1704 STATE LICENSE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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