Healthcare Provider Details

I. General information

NPI: 1356499453
Provider Name (Legal Business Name): BRIAN ISENHOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 W 6200 S
WEST VALLEY CITY UT
84118-7915
US

IV. Provider business mailing address

2531 ALTAMONT CIR
SANDY UT
84092-3301
US

V. Phone/Fax

Practice location:
  • Phone: 801-965-0243
  • Fax: 801-965-0687
Mailing address:
  • Phone: 801-965-0243
  • Fax: 801-965-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1520141701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: