MEDICARE: MARIKO KINJO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	152714-1701	UT

General Provider Information

NPI Number	:	1417240557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIKO KINJO

Provider Business Mailing Address
First Line	:	2266 E 3300 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-2635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2266 E 3300 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84109-2635
Country	:	US
Telephone Number	:	801-485-4852
Fax Number	:	801-485-6790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/23/2011

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Directions to “ MARIKO KINJO ” Practice Location

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