Healthcare Provider Details

I. General information

NPI: 1033767686
Provider Name (Legal Business Name): REGAN M HEALY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

370 S 800 E
BOUNTIFUL UT
84010-3736
US

V. Phone/Fax

Practice location:
  • Phone: 801-309-5949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number6382131-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number6382131-1701
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number6382131-1701
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number6382131-1701
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6382131-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: