Healthcare Provider Details

I. General information

NPI: 1992097513
Provider Name (Legal Business Name): BRYAN TAYLOR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2011
Last Update Date: 05/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 N HARRISVILLE RD
OGDEN UT
84404-3928
US

IV. Provider business mailing address

3829 N 1100 W
PLEASANT VIEW UT
84414-1331
US

V. Phone/Fax

Practice location:
  • Phone: 801-393-6093
  • Fax:
Mailing address:
  • Phone: 801-737-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number321623-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: