=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295299527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAYTON J CARTER PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3489 W 2100 S STE 350
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84119-5897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-324-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 WINCHESTER DR
-----------------------------------------------------
City | STANSBURY PARK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84074-8212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-225-6706
-----------------------------------------------------
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 | 7069676-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------