Healthcare Provider Details

I. General information

NPI: 1558034397
Provider Name (Legal Business Name): KASEY HEUSDENS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7859 S 3200 W
WEST JORDAN UT
84088-5230
US

IV. Provider business mailing address

3297 W UPPER HUNTLY WAY
WEST JORDAN UT
84088-2525
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-7557
  • Fax:
Mailing address:
  • Phone: 720-290-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10960949-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: