Healthcare Provider Details

I. General information

NPI: 1366331803
Provider Name (Legal Business Name): MICHAEL KILEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 S STATE ST
MIDVALE UT
84047-2013
US

IV. Provider business mailing address

4013 W 1040 N # MM304
LEHI UT
84048-7668
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9540
  • Fax:
Mailing address:
  • Phone: 801-633-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number7789027
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number7789027
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7789027
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1295825800
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer
# 2
Identifier1386719821
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: