Healthcare Provider Details

I. General information

NPI: 1619791571
Provider Name (Legal Business Name): LING CULP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 E 800 S
OREM UT
84097-6528
US

IV. Provider business mailing address

896 W 260 S
OREM UT
84058-4200
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10066891-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: