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General NPI Number Information
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NPI Number | 1437860053
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Entity Type | Organization
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Legal Business Name | I2 COLLABORATIVE, LLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 406 W SOUTH JORDAN PKWY STE 450
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-3946
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Country | US
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Telephone | 801-919-3008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | RIVERTON
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State | UT
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Zip | 84065-0550
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Country | US
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Telephone | 801-919-3008
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Fax |
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | GREGORY BAIRD
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Credential | MD
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Telephone | 801-919-3008
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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 |
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License Number State |
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