Healthcare Provider Details

I. General information

NPI: 1265098685
Provider Name (Legal Business Name): JACE MURAMOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11585 S STATE ST STE 106
DRAPER UT
84020-7400
US

IV. Provider business mailing address

11585 S STATE ST STE 106
DRAPER UT
84020-7400
US

V. Phone/Fax

Practice location:
  • Phone: 888-557-4319
  • Fax:
Mailing address:
  • Phone: 888-557-4319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8287
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: