Individual
MISS DOUGLAS GRANT CARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5353 N 11000 N, HIGHLAND, UT 84003
(801) 756-8353
(801) 756-3525
Mailing address
121 N 800 E, AMERICAN FORK, UT 84003-2015
(801) 756-2250
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
140359-1701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870309253012
—
UT
Enumeration date
07/20/2006
Last updated
07/09/2007
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