MEDICARE: MRS. ANDREA CHRISTINE GUNNERSON 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	319319-1701	UT

General Provider Information

NPI Number	:	1669078739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA CHRISTINE GUNNERSON RPH

Provider Business Mailing Address
First Line	:	268 W 3400 S
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-7961
Country	:	US
Telephone Number	:	702-283-8154
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 S 900 W
Second Line	:
City	:	RIVERDALE
State	:	UT
Zip	:	84405-3777
Country	:	US
Telephone Number	:	801-612-3477
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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Directions to “ MRS. ANDREA CHRISTINE GUNNERSON RPH” Practice Location

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