Healthcare Provider Details

I. General information

NPI: 1205188604
Provider Name (Legal Business Name): DIANE BEZZANT OGBORN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E 3500 N
LEHI UT
84043-3530
US

IV. Provider business mailing address

1550 S REDWOOD RD
SALT LAKE CITY UT
84104-5105
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-6515
  • Fax: 801-341-6516
Mailing address:
  • Phone: 801-341-6515
  • Fax: 801-341-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7070797-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: