Healthcare Provider Details

I. General information

NPI: 1235803461
Provider Name (Legal Business Name): MICHAEL BRYAN SMITH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E 1ST AVE APT 101
SALT LAKE CITY UT
84103-2598
US

IV. Provider business mailing address

131 E 1ST AVE APT 101
SALT LAKE CITY UT
84103-2598
US

V. Phone/Fax

Practice location:
  • Phone: 801-699-1622
  • Fax:
Mailing address:
  • Phone: 801-699-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number9111270-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: