Healthcare Provider Details

I. General information

NPI: 1760854582
Provider Name (Legal Business Name): CHANCE KEDDINGTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 WEST 12600 SOUTH , SUITE 170
RIVERTON UT
84065
US

IV. Provider business mailing address

3723 WEST 12600 SOUTH , SUITE 170
RIVERTON UT
84065
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-4500
  • Fax:
Mailing address:
  • Phone: 801-285-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6789054-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: