Healthcare Provider Details

I. General information

NPI: 1336785872
Provider Name (Legal Business Name): KARALYNNE MICHELLE THACKER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2483 N MAIN ST
TOOELE UT
84074-3641
US

IV. Provider business mailing address

5560 LORRAINE WAY
STANSBURY PARK UT
84074-8100
US

V. Phone/Fax

Practice location:
  • Phone: 435-241-5145
  • Fax: 435-248-0069
Mailing address:
  • Phone: 801-541-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7111262-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19658
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: