Healthcare Provider Details

I. General information

NPI: 1669078739
Provider Name (Legal Business Name): ANDREA CHRISTINE GUNNERSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 S 900 W
RIVERDALE UT
84405-3777
US

IV. Provider business mailing address

268 W 3400 S
BOUNTIFUL UT
84010-7961
US

V. Phone/Fax

Practice location:
  • Phone: 801-612-3477
  • Fax:
Mailing address:
  • Phone: 702-283-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number319319-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: