Provider Demographics
NPI:1437583994
Name:BROSCHINSKY, SCOTT LEE (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEE
Last Name:BROSCHINSKY
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 1:3348 W HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2819
Mailing Address - Country:US
Mailing Address - Phone:801-707-2355
Mailing Address - Fax:
Practice Address - Street 1:3330 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-1318
Practice Address - Country:US
Practice Address - Phone:801-966-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145556-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist