Provider Demographics
NPI:1093080673
Name:ALBERTS, PRESTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:ALBERTS
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 1:835 N 3050 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-9041
Mailing Address - Country:US
Mailing Address - Phone:435-256-0002
Mailing Address - Fax:
Practice Address - Street 1:835 N 3050 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9041
Practice Address - Country:US
Practice Address - Phone:435-256-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7116292-1701183500000X
AZS018541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist