MEDICARE: PATRICIA THAXTON RPH

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	1515151701	UT

General Provider Information

NPI Number	:	1285739961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA THAXTON RPH

Provider Business Mailing Address
First Line	:	3652 KAIBAB CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2309
Country	:	US
Telephone Number	:	801-673-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3652 KAIBAB CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2309
Country	:	US
Telephone Number	:	801-673-8391
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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