Individual
KARALYNNE MICHELLE THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
8055 W 3500 S, MAGNA, UT 84044-2218
(801) 250-6900
Mailing address
5560 LORRAINE WAY, STANSBURY PARK, UT 84074-8100
(801) 541-4851
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
19658
NV
183500000X
Pharmacist
Primary
7111262-1701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19658
NEVADA PHARMACIST LICENSE
NV
01
—
7111262-1701
UTAH PHARMACIST LICENSE
UT
Enumeration date
11/19/2019
Last updated
11/19/2019
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