Provider Demographics
NPI:1568062081
Name:WEBB, DAVID BRENT (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENT
Last Name:WEBB
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 1:7970 S BROKEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-7203
Mailing Address - Country:US
Mailing Address - Phone:775-443-7412
Mailing Address - Fax:
Practice Address - Street 1:4570 S 4000 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-6232
Practice Address - Country:US
Practice Address - Phone:801-969-1424
Practice Address - Fax:801-969-8116
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6979183500000X
UT6370797-1701183500000X
NV18291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist