MEDICARE: BRYAN GARTH THOMPSON 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	5410433-1701	UT

General Provider Information

NPI Number	:	1962139147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN GARTH THOMPSON PHARMD

Provider Business Mailing Address
First Line	:	3955 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-3307
Country	:	US
Telephone Number	:	801-966-1497
Fax Number	:	801-957-8134

Provider Business Practice Location Address
First Line	:	3955 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-3307
Country	:	US
Telephone Number	:	801-966-1497
Fax Number	:	801-957-8134

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

Provider Enumeration Date	:	08/06/2022
Last Update Date	:	08/06/2022

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