=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609422310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYME ANN HENRIETTA GARCIA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2019
-----------------------------------------------------
Last Update Date | 08/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 S REDWOOD RD
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84104-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-974-1347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8493 S 6070 W
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84081-3448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-264-1311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 8088152-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------