Healthcare Provider Details

I. General information

NPI: 1649186883
Provider Name (Legal Business Name): JACOB WATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E 3500 N
LEHI UT
84043-3530
US

IV. Provider business mailing address

1550 E 3500 N
LEHI UT
84043-3530
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9535787-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: