Healthcare Provider Details

I. General information

NPI: 1508517137
Provider Name (Legal Business Name): CHANCE WARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

IV. Provider business mailing address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax: 801-364-4392
Mailing address:
  • Phone: 801-359-2256
  • Fax: 801-364-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8805790-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number21098
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: