Healthcare Provider Details

I. General information

NPI: 1982275277
Provider Name (Legal Business Name): HANNAH TA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 E 800 S
OREM UT
84097-6528
US

IV. Provider business mailing address

4491 S CAPE VISTA WAY
WEST VALLEY CITY UT
84128-7746
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-5003
  • Fax:
Mailing address:
  • Phone: 801-864-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8548758-1701
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: