Individual
STACY RAE HARBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 S 300 W, SALT LAKE CITY, UT 84101-3053
(801) 401-9563
Mailing address
6431 S 1865 E, SALT LAKE CITY, UT 84121-2119
(801) 440-4063
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7115078-1701
UT
Other
Enumeration date
07/29/2011
Last updated
07/29/2011
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