Individual
MR. GEORGE JOEL THACKER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD.
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-3843
Mailing address
203 N 1200 W APT 101, OREM, UT 84057-4588
(801) 369-7434
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6226993-1701
UT
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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