Provider Demographics
NPI:1326456740
Name:SUGDEN, SKYLER
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:SUGDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 W ELK VISTA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9558
Mailing Address - Country:US
Mailing Address - Phone:801-865-8348
Mailing Address - Fax:
Practice Address - Street 1:3749 W ELK VISTA LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9558
Practice Address - Country:US
Practice Address - Phone:801-865-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6235629-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist