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NPI Code Detail

MEDICARE: MS. LESLIE ANNE GREGERSEN R.PH

MEDICARE: MS. LESLIE ANNE GREGERSEN R.PH
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
1183500000XPharmacist150873-1719UT

General Provider Information

NPI Number : 1285624197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LESLIE ANNE GREGERSEN R.PH
Provider Business Mailing Address
First Line : 3738 OAKRIDGE CT
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84010-5868
Country : US
Telephone Number : 801-397-0788
Fax Number : 801-213-9160
Provider Business Practice Location Address
First Line : 1525 W 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84119-1401
Country : US
Telephone Number : 801-213-9150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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