Provider Demographics
NPI:1003411877
Name:MENSSEN, DAVID TODD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:MENSSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 E 9000 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2424
Mailing Address - Country:US
Mailing Address - Phone:901-255-9699
Mailing Address - Fax:
Practice Address - Street 1:667 E 9000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2424
Practice Address - Country:US
Practice Address - Phone:901-255-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT74521112-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist