MEDICARE: MCKAYLA POULSEN 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	9051498-1701	UT

General Provider Information

NPI Number	:	1669089363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAYLA POULSEN PHARMD

Provider Business Mailing Address
First Line	:	1259 E LORI CIR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-1915
Country	:	US
Telephone Number	:	801-815-5733
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1641
Country	:	US
Telephone Number	:	801-467-0152
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	09/26/2020

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Directions to “ MCKAYLA POULSEN PHARMD” Practice Location

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