Provider Demographics
NPI:1225658255
Name:GEDDES, PAULA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MICHELLE
Last Name:GEDDES
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 1:179 EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-1764
Mailing Address - Country:US
Mailing Address - Phone:801-809-5305
Mailing Address - Fax:
Practice Address - Street 1:8074 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-0743
Practice Address - Country:US
Practice Address - Phone:801-561-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5352246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1835P0018XMedicaid