Healthcare Provider Details

I. General information

NPI: 1114209012
Provider Name (Legal Business Name): JEREMY JOSEPH STANGER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 200 W
BOUNTIFUL UT
84010-7249
US

IV. Provider business mailing address

555 S 200 W
BOUNTIFUL UT
84010-7249
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-7833
  • Fax: 801-397-7827
Mailing address:
  • Phone: 801-397-7833
  • Fax: 801-397-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number7114777-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: