Healthcare Provider Details

I. General information

NPI: 1174930457
Provider Name (Legal Business Name): KELLY STARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR
SALT LAKE CITY UT
84148-1545
US

IV. Provider business mailing address

500 FOOTHILL DR
SALT LAKE CITY UT
84148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-843-8728
  • Fax:
Mailing address:
  • Phone: 402-843-8728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7091
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberP7091
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: