Healthcare Provider Details

I. General information

NPI: 1710656970
Provider Name (Legal Business Name): DENNIS JAMES WHITWORTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 NORTH STATE STREET ADDRESS LINE 2
OREM UT
84057
US

IV. Provider business mailing address

406 N STATE STREET ADDRESS LINE 2
OREM UT
84057
US

V. Phone/Fax

Practice location:
  • Phone: 801-434-7670
  • Fax:
Mailing address:
  • Phone: 801-434-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8089566-8911
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: