Healthcare Provider Details

I. General information

NPI: 1053952556
Provider Name (Legal Business Name): ELIZABETH S PAPENFUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S INTERMOUNTAIN DR
MURRAY UT
84107-6024
US

IV. Provider business mailing address

5201 S INTERMOUNTAIN DR
MURRAY UT
84107-6024
US

V. Phone/Fax

Practice location:
  • Phone: 801-290-4202
  • Fax: 801-290-4223
Mailing address:
  • Phone: 801-290-4202
  • Fax: 801-290-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number355722-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: