Provider Demographics
NPI:1417279159
Name:MATHIAS, DENNIS DALE (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:DALE
Last Name:MATHIAS
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 1:264 S MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:UT
Mailing Address - Zip Code:84654-5537
Mailing Address - Country:US
Mailing Address - Phone:435-529-3547
Mailing Address - Fax:
Practice Address - Street 1:264 S MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-5537
Practice Address - Country:US
Practice Address - Phone:435-529-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1415541701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist