Healthcare Provider Details

I. General information

NPI: 1942234570
Provider Name (Legal Business Name): DAVID DEAN BISHOP R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD.
SALT LAKE CITY UT
84148
US

IV. Provider business mailing address

8440 COLENE DRIVE
SANDY UT
84094
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 801-561-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number143754-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: