Healthcare Provider Details

I. General information

NPI: 1467461160
Provider Name (Legal Business Name): KEVIN A THOMAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 400 N
OREM UT
84057-1950
US

IV. Provider business mailing address

505 W 400 N
OREM UT
84057-1950
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-3511
  • Fax: 801-714-3516
Mailing address:
  • Phone: 801-714-3511
  • Fax: 801-714-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number148370-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: