Healthcare Provider Details

I. General information

NPI: 1881736601
Provider Name (Legal Business Name): KATHLEEN M PHILLIPS RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-587-7189
  • Fax: 801-587-7195
Mailing address:
  • Phone: 801-587-7189
  • Fax: 801-587-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number148258-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: