Healthcare Provider Details

I. General information

NPI: 1265546584
Provider Name (Legal Business Name): JASON ALLEN DUNN CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E VINE ST
SALT LAKE CITY UT
84121
US

IV. Provider business mailing address

2080 E CARRIAGE CHASE LN
SANDY UT
84092
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-7455
  • Fax: 801-288-2672
Mailing address:
  • Phone: 801-943-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number342675-1717
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: