Healthcare Provider Details

I. General information

NPI: 1518509223
Provider Name (Legal Business Name): JESSICA MANSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 200 W
BOUNTIFUL UT
84010-7249
US

IV. Provider business mailing address

235 NAUTICAL DR
STANSBURY PARK UT
84074-8175
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-7833
  • Fax:
Mailing address:
  • Phone: 801-870-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6674348-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: