MEDICARE: KYLEE SHUMWAY PHARMD

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	6372629-8911	UT
2	183500000X	Pharmacist	6372629-1701	UT

General Provider Information

NPI Number	:	1316452410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEE SHUMWAY PHARMD

Provider Business Mailing Address
First Line	:	669 W 900 N
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2602
Country	:	US
Telephone Number	:	801-294-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 CUTLER DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2966
Country	:	US
Telephone Number	:	853-242-5083
Fax Number	:

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	12/12/2023

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