MEDICARE: ALEXA NICOLE HUMPHRIS

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	10746151-1701	UT

General Provider Information

NPI Number	:	1194604710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA NICOLE HUMPHRIS

Provider Business Mailing Address
First Line	:	1955 SPRING CREEK DR
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-5329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 W PARRISH LN
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-1829
Country	:	US
Telephone Number	:	801-294-6168
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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Directions to “ ALEXA NICOLE HUMPHRIS ” Practice Location

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