Healthcare Provider Details

I. General information

NPI: 1912543299
Provider Name (Legal Business Name): LEXIE HOLBROOK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7061 S REDWOOD RD
WEST JORDAN UT
84084-3420
US

IV. Provider business mailing address

14019 S SAGE HOLLOW DR
DRAPER UT
84020-7524
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-6645
  • Fax:
Mailing address:
  • Phone: 801-414-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number153044-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number153044-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: