Healthcare Provider Details

I. General information

NPI: 1457984965
Provider Name (Legal Business Name): AFTON MELISSA ALLEN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 200 W
BOUNTIFUL UT
84010-7249
US

IV. Provider business mailing address

163 N 900 E
BOUNTIFUL UT
84010-2913
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-7833
  • Fax: 801-397-7827
Mailing address:
  • Phone: 801-706-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5484188-1701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: