Healthcare Provider Details

I. General information

NPI: 1306374806
Provider Name (Legal Business Name): DEVAN LEE DAVIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

469 W ASPEN HILLS BLVD
SARATOGA SPRINGS UT
84045-4770
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1680
  • Fax: 801-662-1688
Mailing address:
  • Phone: 801-668-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7069517-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: