Provider Demographics
NPI:1336294545
Name:MYLER, DOUGLAS JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:MYLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 SOUTH 2350 WEST
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2207
Mailing Address - Country:US
Mailing Address - Phone:801-773-8860
Mailing Address - Fax:801-627-0072
Practice Address - Street 1:4848 SOUTH 900 WEST
Practice Address - Street 2:WAL MART PHARMACY
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3726
Practice Address - Country:US
Practice Address - Phone:801-627-0069
Practice Address - Fax:801-627-0072
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1482351701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist