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General NPI Number Information
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NPI Number | 1568075463
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Entity Type | Individual
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Provider Name | BRENT WEST
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Gender | Male
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 19 W CLOVER LN
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City | WASHINGTON
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State | UT
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Zip | 84780-8208
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Country | US
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Telephone | 435-669-8526
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Fax |
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Provider Business Mailing Address
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Address Line | 835 N 3050 E
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City | ST GEORGE
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State | UT
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Zip | 84790-9041
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Country | US
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Telephone |
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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 | 10429029-1701
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License Number State | UT
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