MEDICARE: AMBER MECHAM OVERTON 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	2001024186	MO
2	183500000X	Pharmacist	354572-1701	UT

General Provider Information

NPI Number	:	1710024534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MECHAM OVERTON PHARMD

Provider Business Mailing Address
First Line	:	1801 YUMA ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2926
Country	:	US
Telephone Number	:	801-486-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 ARAPEEN DR
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1223
Country	:	US
Telephone Number	:	801-587-8600
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/14/2007

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