Individual
DR. CAMILLE BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4080 W 9000 S, WEST JORDAN, UT 84088-8928
(801) 280-5545
Mailing address
4080 W 9000 S, WEST JORDAN, UT 84088-8928
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
352072-1701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
352072-1701
—
UT
Enumeration date
10/05/2019
Last updated
10/05/2019
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