Individual
BRENDA LEE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
729 N REDWOOD RD, SALT LAKE CITY, UT 84116-1909
(801) 532-3795
(801) 532-4909
Mailing address
PO BOX 16495, SALT LAKE CITY, UT 84116
(801) 532-3795
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
9250968-1717
UT
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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