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General NPI Number Information
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NPI Number | 1386285294
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Entity Type | Individual
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Provider Name | BRYAN CHRISTENSEN
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Gender | Male
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 1634 W SOUTH JORDAN PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4562
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Country | US
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Telephone | 801-254-0068
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Fax | 801-253-2561
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Provider Business Mailing Address
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Address Line | 11548 S WATERSIDE RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-7937
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Country | US
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Telephone | 801-440-3522
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 150182-1701
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License Number State | UT
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