Healthcare Provider Details

I. General information

NPI: 1699705558
Provider Name (Legal Business Name): BONNIE KATHLEEN PORTLEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHARMACY SERVICES #119 500 FOOTHILL BLVD.
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

PHARMACY SERVICES #119 500 FOOTHILL BLVD.
SALT LAKE CITY UT
84148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2587
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2737311701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: