Healthcare Provider Details

I. General information

NPI: 1780703975
Provider Name (Legal Business Name): DENA HENLEY CARNES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 N MAPLE DRIVE
EAGLE MOUNTAIN UT
84005
US

IV. Provider business mailing address

4444 N MAPLE DRIVE
EAGLE MOUNTAIN UT
84005
US

V. Phone/Fax

Practice location:
  • Phone: 801-789-2362
  • Fax:
Mailing address:
  • Phone: 801-789-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6309627-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: