Healthcare Provider Details

I. General information

NPI: 1376573337
Provider Name (Legal Business Name): DEBRA JEANE RENNER MACDONALD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

3283 MEADOWS DR
PARK CITY UT
84060-6806
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2530
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7032
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37023
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number151125-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: