Individual
EDEM KOFFI AMEVOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3215 S VALLEY ST, SALT LAKE CITY, UT 84109-4217
(801) 486-8477
Mailing address
3215 S VALLEY ST, SALT LAKE CITY, UT 84109-4217
(801) 486-8477
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6432485-1701
UT
Other
Enumeration date
10/05/2019
Last updated
10/05/2019
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