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General NPI Number Information
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NPI Number | 1336911023
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Entity Type | Individual
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Provider Name | MATTHEW ORTMAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 7302 S BINGHAM JUNCTION BLVD
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City | MIDVALE
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State | UT
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Zip | 84047-4870
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Country | US
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Telephone | 801-442-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 139 E WAYFIELD DR
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City | DRAPER
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State | UT
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Zip | 84020-7972
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Country | US
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Telephone | 832-514-1782
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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 | 13455071
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License Number State | UT
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