Healthcare Provider Details

I. General information

NPI: 1508474404
Provider Name (Legal Business Name): TAYLOR HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
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: 385-374-5485
Mailing address:
  • Phone: 385-374-5480
  • Fax: 385-374-5485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number8999539-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: