Healthcare Provider Details

I. General information

NPI: 1801777842
Provider Name (Legal Business Name): RYAN SPECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 S INTERMOUNTAIN DR
MURRAY UT
84107-6024
US

IV. Provider business mailing address

1498 E 900 S
SLC UT
84105-1620
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11488456-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: