MEDICARE: MRS. DENA HENLEY CARNES 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	6309627-1701	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6309627-1701	OTHER	UT	PHARMACIST'S LICENSE

General Provider Information

NPI Number	:	1780703975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENA HENLEY CARNES RPH

Provider Business Mailing Address
First Line	:	4444 N MAPLE DRIVE
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005
Country	:	US
Telephone Number	:	801-789-2362
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 N MAPLE DRIVE
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005
Country	:	US
Telephone Number	:	801-789-2362
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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