Organization
LIFE SKILLS NUTRITIONAL SUPPLEMENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGIE JEANIE DOHERTY (MANAGER)
(801) 554-1830
Entity
Organization
Contact information
Practice address
6912 S 185 W, SUITE A, MIDVALE, UT 84047-3719
(801) 554-1830
(801) 858-2626
Mailing address
15173 ROSE CANYON RD, HERRIMAN, UT 84065-4482
(801) 554-1830
(801) 858-2626
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
20021545
UT
Other
Enumeration date
08/26/2005
Last updated
12/02/2008
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