Healthcare Provider Details

I. General information

NPI: 1275272833
Provider Name (Legal Business Name): KIMBERLY ERCEK PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W CENTER ST
OREM UT
84057-4607
US

IV. Provider business mailing address

12760 S PARK AVE UNIT 1119
RIVERTON UT
84065-3446
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-6510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7027173-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: