INTERMOUNTAIN SOUTHRIDGE PHARMACY
NPI 1649401969
Pharmacy - Community/Retail Pharmacy in Riverton, UT

NPI Status: Active since August 04, 2009

Contact Information

3723 W 12600 S STE 170
RIVERTON, UT
ZIP 84065
Phone: (801) 285-4500
Fax: (801) 285-4501

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  • Organization
  • Pharmacy
  • Community/Retail Pharmacy
  • Accepts Insurance

About INTERMOUNTAIN SOUTHRIDGE PHARMACY

This page provides the complete NPI Profile along with additional information for Intermountain Southridge Pharmacy, a provider established in Riverton, Utah operating as a Pharmacy, focusing in community/retail pharmacy . The healthcare provider is registered in the NPI registry with number 1649401969 assigned on August 2009. The practitioner's primary taxonomy code is 3336C0003X with license number 7359499-1703 (UT). The provider is registered as an organization and their NPI record was last updated 7 years ago. The provider's is doing business as Intermountain Southridge Pharmacy. The authorized official of this NPI record is Nannette Berensen (Vice President Of Clinical Systems)

NPI
1649401969
Provider Legal Name
IHC HEALTH SERVICES INC
Other Organization Name
INTERMOUNTAIN SOUTHRIDGE PHARMACY
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
3723 W 12600 S STE 170 RIVERTON, UT 84065
Location Phone
(801) 285-4500
Location Fax
(801) 285-4501
Mailing Address
PO BOX 30013 SALT LAKE CITY, UT 84130
Mailing Phone
(801) 285-4500
Mailing Fax
(801) 285-4501
Is Sole Proprietor?
No
Is Organization Subpart?
Yes
Enumeration Date
08-04-2009
Last Update Date
07-19-2018
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Pharmacy Community/Retail Pharmacy

Taxonomy Code
3336C0003X
Type
Suppliers
License No.
7359499-1703
License State
UT
Taxonomy Description
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1333600000XSuppliers

Pharmacy

 
23336C0004XSuppliers

Pharmacy
Compounding Pharmacy

 

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Select by Medica Bronze $0 Copay PCP Visits - EPO
  • Select by Medica Bronze Share - EPO
  • Select by Medica Expanded Bronze Standard - EPO
  • Select by Medica Gold $0 Copay PCP Visits - EPO
  • Select by Medica Gold Share - EPO
  • Select by Medica Gold Standard - EPO
  • Select by Medica Silver $0 Copay PCP Visits - EPO
  • Select by Medica Silver Share - EPO
  • Select by Medica Silver Standard - EPO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

NANNETTE BERENSEN

Authorized Official Title
VICE PRESIDENT OF CLINICAL SYSTEMS
Authorized Official Phone
(801) 284-1005

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
2121208OTHER (01)PK
1649401969MEDICAID (05)UT 
1649401969MEDICAID (05)ID 
1649401969MEDICAID (05)WY 

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1649401969
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2689802912
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 8 + 9 + 8 + 0 + 2 + 9 + 1 + 2 + 24 = 71
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 71 = 99

The NPI number 1649401969 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1568925196 AUSTIN DONALD REESE PHARMD
Individual
Pharmacist3723 W 12600 S STE 170
RIVERTON, UT 84065
(801) 285-4500

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1649401969, enumerated in the NPI registry as an "organization" on August 04, 2009

The provider is located at 3723 W 12600 S Ste 170 Riverton, Ut 84065 and the phone number is (801) 285-4500

This medical organization specializes in Pharmacy with taxonomy code 3336C0003X with a focus in Community/Retail Pharmacy

The provider might be accepting Accepts: Medica, Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

This NPI record was last updated on August 04, 2009. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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