MEDICARE: DENISE M SMALL PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1329561719	UT

General Provider Information

NPI Number	:	1033189543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE M SMALL PHARM.D.

Provider Business Mailing Address
First Line	:	972 FALLBROOK WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-1614
Country	:	US
Telephone Number	:	801-563-9545
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ARAPEEN DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1267
Country	:	US
Telephone Number	:	801-587-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/08/2007

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