Healthcare Provider Details

I. General information

NPI: 1780975649
Provider Name (Legal Business Name): JOHN HEATH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 S 300 W
SALT LAKE CITY UT
84115-1805
US

IV. Provider business mailing address

457 N 300 W
SLC UT
84103-1220
US

V. Phone/Fax

Practice location:
  • Phone: 801-485-9885
  • Fax:
Mailing address:
  • Phone: 801-598-1669
  • Fax: 801-485-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number266074-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number266074-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: