MEDICARE: ZACHARY BASS CPHT

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	183700000X	Pharmacy Technician	5579896-1717	UT

General Provider Information

NPI Number	:	1063951986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY BASS CPHT

Provider Business Mailing Address
First Line	:	4624 S HOLLADAY BLVD
Second Line	:	STE101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7054
Country	:	US
Telephone Number	:	801-316-0790
Fax Number	:	801-316-0791

Provider Business Practice Location Address
First Line	:	4624 S HOLLADAY BLVD
Second Line	:	STE101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-7054
Country	:	US
Telephone Number	:	801-316-0790
Fax Number	:	801-316-0791

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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