Healthcare Provider Details

I. General information

NPI: 1689654329
Provider Name (Legal Business Name): WILLIAM DELL CRAYNOR R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N 2200 W
SALT LAKE CITY UT
84116-2905
US

IV. Provider business mailing address

134 COTTONWOOD DR
OGDEN UT
84414-1180
US

V. Phone/Fax

Practice location:
  • Phone: 801-595-4375
  • Fax: 801-595-2075
Mailing address:
  • Phone: 801-595-4375
  • Fax: 801-595-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number140651-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: