Healthcare Provider Details

I. General information

NPI: 1558738310
Provider Name (Legal Business Name): BRYAN WALKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 HARRISON BLVD
OGDEN UT
84404-6093
US

IV. Provider business mailing address

1485 HARRISON BLVD
OGDEN UT
84404-6093
US

V. Phone/Fax

Practice location:
  • Phone: 801-458-9172
  • Fax:
Mailing address:
  • Phone: 801-458-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5618906-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5618906-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: