Healthcare Provider Details

I. General information

NPI: 1699045963
Provider Name (Legal Business Name): JENNIFER JEPPSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E 2100 S
SALT LAKE CITY UT
84106-2321
US

IV. Provider business mailing address

909 E 2100 S
SALT LAKE CITY UT
84106-2321
US

V. Phone/Fax

Practice location:
  • Phone: 801-463-4870
  • Fax: 801-463-7027
Mailing address:
  • Phone: 801-463-4870
  • Fax: 801-463-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5032867-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: