Healthcare Provider Details

I. General information

NPI: 1346077906
Provider Name (Legal Business Name): CHARLES OAXACA HALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 S 3850 W STE 220
SALT LAKE CITY UT
84104-4939
US

IV. Provider business mailing address

2558 E SIMPSON AVE
SALT LAKE CITY UT
84109-1339
US

V. Phone/Fax

Practice location:
  • Phone: 385-549-1121
  • Fax: 855-571-3472
Mailing address:
  • Phone: 801-604-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number376949-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number376949-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: