Individual
VILAYVONE THIPSOUVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1442 W 9000 S, WEST JORDAN, UT 84088-9218
(801) 562-8978
Mailing address
1442 W 9000 S, WEST JORDAN, UT 84088-9218
(801) 562-8978
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
65038721701
UT
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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