Healthcare Provider Details

I. General information

NPI: 1568487551
Provider Name (Legal Business Name): TYLER JOHN GERRITSEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 2100 S
SALT LAKE CITY UT
84119-1401
US

IV. Provider business mailing address

751 W 2400 N
LEHI UT
84043-3307
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9950
  • Fax: 801-213-9965
Mailing address:
  • Phone: 801-213-9950
  • Fax: 801-213-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5123672-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: