Provider Demographics
NPI:1437705043
Name:MORTENSEN, DONALD SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SCOTT
Last Name:MORTENSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 700 S
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3510
Mailing Address - Country:US
Mailing Address - Phone:801-785-9445
Mailing Address - Fax:
Practice Address - Street 1:210 E 700 S
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3510
Practice Address - Country:US
Practice Address - Phone:801-785-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151954-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist