Healthcare Provider Details

I. General information

NPI: 1942492491
Provider Name (Legal Business Name): DAVIS SCOTT MOORE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W 2100 S
SALT LAKE CITY UT
84119-1401
US

IV. Provider business mailing address

5071 EAGLE ROCK WAY
WEST VALLEY CITY UT
84120-1423
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-9950
  • Fax: 801-213-9965
Mailing address:
  • Phone: 801-213-9950
  • Fax: 801-213-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5017555-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: