Healthcare Provider Details

I. General information

NPI: 1134379506
Provider Name (Legal Business Name): LEON KEITH HUTCHINSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 E 1000 S FORT DUCHESNE INDIAN HEALTH SERVICE
FT DUCHESNE UT
84026
US

IV. Provider business mailing address

6822 EAST 1000 SOUTH FORT DUCHESNE INDIAN HEALTH SERVICE
FORT DUCHESNE UT
84026
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6873
  • Fax:
Mailing address:
  • Phone: 435-725-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR4959
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00018829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: