MEDICARE: DEREK DANIEL GARN 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	P5057	ID
2	183500000X	Pharmacist	152961-1701	UT

General Provider Information

NPI Number	:	1770184194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK DANIEL GARN RPH

Provider Business Mailing Address
First Line	:	510 ARIANE WAY
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-3462
Country	:	US
Telephone Number	:	801-707-1828
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 W PARRISH LN
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-1829
Country	:	US
Telephone Number	:	801-294-6168
Fax Number	:	801-294-6171

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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Directions to “ DEREK DANIEL GARN RPH” Practice Location

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