Healthcare Provider Details

I. General information

NPI: 1497437636
Provider Name (Legal Business Name): LANE DAVID HIGLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST STE 640
MURRAY UT
84107-5701
US

IV. Provider business mailing address

5121 S COTTONWOOD ST STE 640
MURRAY UT
84107-5701
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-4800
  • Fax: 801-507-4699
Mailing address:
  • Phone: 801-507-4800
  • Fax: 801-507-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number4816609-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: