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General NPI Number Information
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NPI Number | 1013369602
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Entity Type | Individual
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Provider Name | BRIAN TULLIS
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Gender | Male
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 774 S STATE ST
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City | OREM
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State | UT
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Zip | 84058-6308
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Country | US
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Telephone | 801-426-6650
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Fax |
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Provider Business Mailing Address
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Address Line | 11976 S WOODRIDGE RD
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City | SANDY
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State | UT
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Zip | 84094-5723
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Country | US
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Telephone | 801-856-7155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5668530-1701
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License Number State | UT
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