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General NPI Number Information
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NPI Number | 1689892192
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Entity Type | Individual
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Provider Name | ROXANNE V THACKER PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1653 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-9221
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Country | US
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Telephone | 801-561-7497
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Fax | 801-561-1813
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Provider Business Mailing Address
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Address Line | 1478 N 260 E
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-9446
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Country | US
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Telephone | 801-785-7855
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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 | 353442-1701
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License Number State | UT
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