=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154698843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID D'LAYNE JAMES RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2011
-----------------------------------------------------
Last Update Date | 12/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4240 HARRISON BLVD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-621-2610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5293 W 3625 S
-----------------------------------------------------
City | HOOPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84315-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-995-1854
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 321800-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------