Healthcare Provider Details

I. General information

NPI: 1245175355
Provider Name (Legal Business Name): MICHAEL J MCCLEMENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W RIDGETOP CV
SOUTH JORDAN UT
84095-8264
US

IV. Provider business mailing address

1151 W RIDGETOP CV
SOUTH JORDAN UT
84095-8264
US

V. Phone/Fax

Practice location:
  • Phone: 801-631-8598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number344091-1717
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: