Healthcare Provider Details

I. General information

NPI: 1578699278
Provider Name (Legal Business Name): CAROLYN G KOWALCHIK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A050 UNIVERSITY HOSPITAL- PHARMACY 50 N MEDICAL DR
SLC UT
84132-0001
US

IV. Provider business mailing address

2040 BLUEBELL DR
BOUNTIFUL UT
84010-1613
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-6704
  • Fax:
Mailing address:
  • Phone: 801-585-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number147593-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: