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Individual

DEREK JAMES TULLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2332 E 2100 S, SALT LAKE CITY, UT 84109-1319
(801) 466-9949
(801) 467-6742
Mailing address
8649 N PINE VALLEY ALY, EAGLE MOUNTAIN, UT 84005-5261
(256) 654-0882

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7685428-1701
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7685428-1701
UTAH DEPARTMENT OF PROFESSIONAL LICENSING
UT
01
7685428-8911
UTAH DEPARTMENT OF PROFESSIONAL LICENSING
UT
Enumeration date
08/12/2020
Last updated
08/12/2020
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