Healthcare Provider Details

I. General information

NPI: 1194607010
Provider Name (Legal Business Name): RENEE DOUGLASS PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE DOUGLASS PITT PHARMD, BCPS

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH AVENUE C STREET EAST
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

8TH AVENUE C STREET EAST
SALT LAKE CITY UT
84143-5004
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-1100
  • Fax:
Mailing address:
  • Phone: 801-408-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6665449-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: