Healthcare Provider Details

I. General information

NPI: 1861532285
Provider Name (Legal Business Name): BENJAMIN C GEBHART PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR DEPARTMENT A050
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

1146 EMERSON AVENUE
SALT LAKE CITY UT
84105
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2167
  • Fax:
Mailing address:
  • Phone: 801-879-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5145422-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: