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NPI Code Detail

MEDICARE: DIVERSIFIED PROFESSIONAL COMPANY

MEDICARE: DIVERSIFIED PROFESSIONAL COMPANY
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
13336C0004XCompounding Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487736161
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERSIFIED PROFESSIONAL COMPANY
Provider Business Mailing Address
First Line : 1159 E 12TH STREET
Second Line :
City : OGDEN
State : UT
Zip : 84404-5144
Country : US
Telephone Number : 801-334-3190
Fax Number : 801-334-3193
Provider Business Practice Location Address
First Line : 1159 E 12TH STREET
Second Line :
City : OGDEN
State : UT
Zip : 84404-5144
Country : US
Telephone Number : 801-334-3190
Fax Number : 801-334-3193
Authorized Official
Title or Position : PRESIDENT
Name : MR. GARY LYNN BAILEY
Credential : RPH
Telephone Number : 801-334-3190
Provider Enumeration Date : 10/20/2006
Last Update Date : 08/22/2020

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Directions to “DIVERSIFIED PROFESSIONAL COMPANY ” Practice Location

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