=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770183576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALE BATT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2020
-----------------------------------------------------
Last Update Date | 10/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 W TELEGRAPH ST
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84780-1541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-628-5424
-----------------------------------------------------
Fax | 435-656-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 S WASHINGTON FIELDS RD UNIT 7
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84780-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-772-1350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 4892209-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------