Healthcare Provider Details

I. General information

NPI: 1205235736
Provider Name (Legal Business Name): STEPHANIE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 W 7800 S
WEST JORDAN UT
84081-5436
US

IV. Provider business mailing address

5710 W 7800 S
WEST JORDAN UT
84081-5436
US

V. Phone/Fax

Practice location:
  • Phone: 801-545-3480
  • Fax:
Mailing address:
  • Phone: 801-545-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1205235736
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: