Healthcare Provider Details

I. General information

NPI: 1033189543
Provider Name (Legal Business Name): DENISE M SMALL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ARAPEEN DR
SALT LAKE CITY UT
84108-1267
US

IV. Provider business mailing address

972 FALLBROOK WAY
SANDY UT
84094-1614
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-3937
  • Fax:
Mailing address:
  • Phone: 801-563-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1329561719
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: