Healthcare Provider Details

I. General information

NPI: 1912145988
Provider Name (Legal Business Name): RIC L SYKES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11328 S JORDAN GTWY
SOUTH JORDAN UT
84095-4112
US

IV. Provider business mailing address

11328 S JORDAN GTWY
SOUTH JORDAN UT
84095-4112
US

V. Phone/Fax

Practice location:
  • Phone: 801-231-6450
  • Fax: 801-571-2293
Mailing address:
  • Phone: 801-231-6450
  • Fax: 801-571-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number154050-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: