Healthcare Provider Details

I. General information

NPI: 1164666327
Provider Name (Legal Business Name): KERI LYNN FAKATA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 S 700 E SUITE 200
SALT LAKE CITY UT
84106-1466
US

IV. Provider business mailing address

3838 S 700 E SUITE 200
SALT LAKE CITY UT
84106-1466
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-4988
  • Fax: 801-269-9427
Mailing address:
  • Phone: 801-261-4988
  • Fax: 801-269-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number4946621-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: