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NPI Code Detail

MEDICARE: DR. CARRIE DEKORTE PHARMD, BCPS

MEDICARE: DR. CARRIE DEKORTE PHARMD, BCPS
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
11835P1200XPharmacotherapy Pharmacist103639AZ

General Provider Information

NPI Number : 1497758759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARRIE DEKORTE PHARMD, BCPS
Provider Business Mailing Address
First Line : 1584 S 1600 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2823
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 FOOTHILL DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84148-0001
Country : US
Telephone Number : 801-582-1565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 07/08/2007

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