Healthcare Provider Details

I. General information

NPI: 1831013044
Provider Name (Legal Business Name): ANDREW KILLPACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST
BOUNTIFUL UT
84010-6236
US

IV. Provider business mailing address

6215 N ROBINSON LN
MOUNTAIN GREEN UT
84050-4000
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-3439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6857987
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: