Healthcare Provider Details

I. General information

NPI: 1780783274
Provider Name (Legal Business Name): LARRY MCQUADE KEARNS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W UNIVERSITY PKWY
OREM UT
84058-7316
US

IV. Provider business mailing address

1320 E 150 N
PLEASANT GROVE UT
84062-3002
US

V. Phone/Fax

Practice location:
  • Phone: 801-234-8510
  • Fax: 801-234-8522
Mailing address:
  • Phone: 801-234-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0141403-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: