Healthcare Provider Details

I. General information

NPI: 1023608361
Provider Name (Legal Business Name): DR. MAREN HAZEN BAUMGARTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 CHAMBERS ST
OGDEN UT
84403-5181
US

IV. Provider business mailing address

1028 CHAMBERS ST
OGDEN UT
84403-5181
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0331
  • Fax:
Mailing address:
  • Phone: 801-479-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2774266-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: