Provider Demographics
NPI:1205977162
Name:WARREN RX ENTERPRISES INC
Entity type:Organization
Organization Name:WARREN RX ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-225-2150
Mailing Address - Street 1:865 N 980 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-7710
Mailing Address - Country:US
Mailing Address - Phone:801-225-2150
Mailing Address - Fax:801-225-2388
Practice Address - Street 1:865 N 980 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7710
Practice Address - Country:US
Practice Address - Phone:801-735-2003
Practice Address - Fax:801-225-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
UT7214363-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1205977162Medicaid
2106868OtherPK
2106868OtherPK