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General NPI Number Information
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NPI Number | 1356499453
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Entity Type | Individual
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Provider Name | BRIAN ISENHOUR
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5675 W 6200 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84118-7915
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Country | US
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Telephone | 801-965-0243
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Fax | 801-965-0687
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Provider Business Mailing Address
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Address Line | 2531 ALTAMONT CIR
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City | SANDY
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State | UT
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Zip | 84092-3301
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Country | US
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Telephone | 801-965-0243
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Fax | 801-965-0687
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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 | 1520141701
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License Number State | UT
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