Provider Demographics
NPI:1285852392
Name:GARDINER, ALICIA KIM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:KIM
Last Name:GARDINER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:KIM
Other - Last Name:GARDINER-BRAEGGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1229 NO 70 EAST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-492-1241
Mailing Address - Fax:801-855-2938
Practice Address - Street 1:1159 E 200 NO
Practice Address - Street 2:STE 125
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-855-2935
Practice Address - Fax:801-855-2938
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2755461701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist