Individual
THOMAS ALAN GOOD LANCE WHITE BULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
500 FOOTHILL DR, SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
809 AVALON HILLS DR, OGDEN, UT 84404-6654
(801) 928-1269
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
9752695-1717
UT
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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