Provider Demographics
NPI:1528220589
Name:DEMASS, KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DEMASS
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 1:82 SOUTH 1100 EAST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-521-6353
Mailing Address - Fax:801-521-6390
Practice Address - Street 1:82 S 1100 E
Practice Address - Street 2:SUITE 104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1686
Practice Address - Country:US
Practice Address - Phone:801-521-6353
Practice Address - Fax:801-521-6390
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1537661701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist