Healthcare Provider Details

I. General information

NPI: 1639489461
Provider Name (Legal Business Name): MUNIR M MERCHANT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 GREENPINE DR
MURRAY UT
84123
US

IV. Provider business mailing address

32 WANDERWOOD WAY
SANDY UT
84092
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-6980
  • Fax: 801-263-6503
Mailing address:
  • Phone: 801-262-6980
  • Fax: 801-263-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number1463831701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number3352
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberP5814
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberS017935
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: