Individual
CARLOS AUGUSTO MIJARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY INTERN
Contact information
Practice address
10920 RIVER FRONT PKWY, SOUTH JORDAN, UT 84095-3538
(801) 302-2600
Mailing address
1750 S 1400 E, C/O MARK DALLIN, SPANISH FORK, UT 84660-9704
(801) 787-6828
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
7210693-1702
UT
Other
Enumeration date
11/09/2010
Last updated
11/09/2010
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