Healthcare Provider Details

I. General information

NPI: 1932545514
Provider Name (Legal Business Name): MICHAEL D JEPSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 N REDWOOD RD
SARATOGA SPRINGS UT
84045-5190
US

IV. Provider business mailing address

689 N REDWOOD RD
SARATOGA SPRINGS UT
84045-5190
US

V. Phone/Fax

Practice location:
  • Phone: 385-374-5480
  • Fax:
Mailing address:
  • Phone: 385-374-5480
  • Fax: 385-374-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number287212-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: