Healthcare Provider Details

I. General information

NPI: 1275442055
Provider Name (Legal Business Name): JUSTYCE JUERGENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 400 S APT 730
SALT LAKE CITY UT
84111-3065
US

IV. Provider business mailing address

330 E 400 S APT 730
SALT LAKE CITY UT
84111-3065
US

V. Phone/Fax

Practice location:
  • Phone: 801-941-9376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14043418-1702
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: