Healthcare Provider Details

I. General information

NPI: 1083563027
Provider Name (Legal Business Name): DANIEL LONGMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E 750 N
OREM UT
84097-4345
US

IV. Provider business mailing address

1292 E 1520 S
SPANISH FORK UT
84660-5942
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-3880
  • Fax:
Mailing address:
  • Phone: 208-242-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7971670-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: