Healthcare Provider Details

I. General information

NPI: 1417237520
Provider Name (Legal Business Name): CAMERON STUART DAWSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S 2000 E SKAGGS HALL, ROOM #15
SALT LAKE CITY UT
84112-5820
US

IV. Provider business mailing address

1709 MEADOWMOOR RD
HOLLADAY UT
84117-5996
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-5317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6675841-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: