MEDICARE: AMY L CALDWELL

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	6217713-1717	UT

General Provider Information

NPI Number	:	1083570584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L CALDWELL

Provider Business Mailing Address
First Line	:	1715 E 5825 S APT 1
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-5220
Country	:	US
Telephone Number	:	385-423-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 E 5825 S APT 1
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-5220
Country	:	US
Telephone Number	:	385-423-1260
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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