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General NPI Number Information
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NPI Number | 1336424498
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Entity Type | Individual
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Provider Name | JEREMIAH DANIEL HALSTEAD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 95 E CENTER ST
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City | PANGUITCH
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State | UT
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Zip | 84759
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Country | US
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Telephone | 435-676-2212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 123
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City | GLENDALE
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State | UT
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Zip | 84729
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Country | US
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Telephone | 509-879-2951
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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 | PH 60226509
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12970664-1701
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License Number State | UT
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