MEDICARE: RANDILYN DANGERFIELD

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	8092073-1701	UT

General Provider Information

NPI Number	:	1275175143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDILYN DANGERFIELD

Provider Business Mailing Address
First Line	:	5620 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-4338
Country	:	US
Telephone Number	:	801-966-6546
Fax Number	:

Provider Business Practice Location Address
First Line	:	5620 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-4338
Country	:	US
Telephone Number	:	801-966-6546
Fax Number	:

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

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ RANDILYN DANGERFIELD ” Practice Location

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