Healthcare Provider Details

I. General information

NPI: 1689709263
Provider Name (Legal Business Name): JACQUELINE MAE MEIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 HIGH TECH DR SUITE 102
MIDVALE UT
84047-3705
US

IV. Provider business mailing address

6297 LAURITZEN DR
WEST JORDAN UT
84084-1216
US

V. Phone/Fax

Practice location:
  • Phone: 801-233-6100
  • Fax: 801-233-6139
Mailing address:
  • Phone: 801-964-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number153831-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: