MEDICARE: BRUCE E LEAVITT PHARM.D.

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	151778-1701	UT

General Provider Information

NPI Number	:	1699748863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE E LEAVITT PHARM.D.

Provider Business Mailing Address
First Line	:	5502 FJORD CIR
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-2357
Country	:	US
Telephone Number	:	801-966-7895
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 10TH AVE
Second Line	:	SUITE 124
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2853
Country	:	US
Telephone Number	:	801-408-3090
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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