Healthcare Provider Details

I. General information

NPI: 1770124638
Provider Name (Legal Business Name): KIMBERLY ZUMWALT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4562
US

IV. Provider business mailing address

1634 W SOUTH JORDAN PKWY
SOUTH JORDAN UT
84095-4562
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-4660
  • Fax: 801-253-2561
Mailing address:
  • Phone: 801-254-4660
  • Fax: 801-253-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number377990-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: