Individual
DOMINIC DEROSE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
1080 W 300 N, CLEARFIELD, UT 84015-8732
(801) 773-7330
Mailing address
1509 WEST STAYNER DRIVE, FARMINGTON, UT 84025
(801) 451-5708
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
140039-1701
UT
Other
Enumeration date
11/30/2005
Last updated
07/08/2007
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