Healthcare Provider Details

I. General information

NPI: 1265076780
Provider Name (Legal Business Name): ELIZABETH STARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W 2600 S
WOODS CROSS UT
84010-8190
US

IV. Provider business mailing address

256 E 2300 S
KAYSVILLE UT
84037-9665
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-2124
  • Fax: 801-299-1634
Mailing address:
  • Phone: 801-499-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5039290-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: