Healthcare Provider Details

I. General information

NPI: 1811818214
Provider Name (Legal Business Name): YARA ELMOAZEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
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

4994 S COMMERCE DR UNIT 359
SALT LAKE CITY UT
84107-4793
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14234111-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: