Provider Demographics
NPI:1467231175
Name:MOULTON, GRANT S (RPH)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:S
Last Name:MOULTON
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 1:2914 E 1880 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5147
Mailing Address - Country:US
Mailing Address - Phone:775-426-9385
Mailing Address - Fax:
Practice Address - Street 1:835 N 3050 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9041
Practice Address - Country:US
Practice Address - Phone:435-256-0002
Practice Address - Fax:435-256-0009
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150832-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist