Provider Demographics
NPI:1558386235
Name:DERBIDGE, R. FERRIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:R.
Middle Name:FERRIS
Last Name:DERBIDGE
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 1:440 E CHASE LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1626
Mailing Address - Country:US
Mailing Address - Phone:801-444-9707
Mailing Address - Fax:
Practice Address - Street 1:1492 W ANTELOPE DR STE 150
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1137
Practice Address - Country:US
Practice Address - Phone:801-779-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT153191-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist