Provider Demographics
NPI:1205188604
Name:OGBORN, DIANE BEZZANT (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:BEZZANT
Last Name:OGBORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-5105
Mailing Address - Country:US
Mailing Address - Phone:801-341-6515
Mailing Address - Fax:801-341-6516
Practice Address - Street 1:1550 E 3500 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3530
Practice Address - Country:US
Practice Address - Phone:801-341-6515
Practice Address - Fax:801-341-6516
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7070797-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist