Healthcare Provider Details

I. General information

NPI: 1669144192
Provider Name (Legal Business Name): BART SMITH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3796 W 12600 S
RIVERTON UT
84065-7312
US

IV. Provider business mailing address

3796 W 12600 S
RIVERTON UT
84065-7312
US

V. Phone/Fax

Practice location:
  • Phone: 801-557-3529
  • Fax:
Mailing address:
  • Phone: 801-557-3529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5556493-8911
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5556493-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: