Healthcare Provider Details

I. General information

NPI: 1871656090
Provider Name (Legal Business Name): LORI CARMONA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR ROOM 1400
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

435 ASPEN DR APT 2
PARK CITY UT
84098-5190
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number290826-1719
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: