Healthcare Provider Details

I. General information

NPI: 1689444101
Provider Name (Legal Business Name): MICHELLE DENAE SPECKMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 W PIONEER PKWY STE 130
WEST VALLEY CITY UT
84120-2059
US

IV. Provider business mailing address

4133 W PIONEER PKWY STE 130
WEST VALLEY CITY UT
84120-2059
US

V. Phone/Fax

Practice location:
  • Phone: 801-403-4934
  • Fax: 888-546-0632
Mailing address:
  • Phone: 801-403-4934
  • Fax: 888-546-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number333237-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: