Healthcare Provider Details

I. General information

NPI: 1265064661
Provider Name (Legal Business Name): JACK WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N MAIN ST
HEBER CITY UT
84032-5515
US

IV. Provider business mailing address

951 E 2740 S
HEBER CITY UT
84032-1226
US

V. Phone/Fax

Practice location:
  • Phone: 435-654-1267
  • Fax:
Mailing address:
  • Phone: 435-503-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9448617-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: