Healthcare Provider Details

I. General information

NPI: 1609422310
Provider Name (Legal Business Name): JAYME ANN HENRIETTA GARCIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S REDWOOD RD
SALT LAKE CITY UT
84104-5105
US

IV. Provider business mailing address

8493 S 6070 W
WEST JORDAN UT
84081-3448
US

V. Phone/Fax

Practice location:
  • Phone: 801-974-1347
  • Fax:
Mailing address:
  • Phone: 951-264-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8088152-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: