Provider Demographics
NPI:1578699278
Name:KOWALCHIK, CAROLYN G (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:KOWALCHIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1613
Mailing Address - Country:US
Mailing Address - Phone:801-585-6704
Mailing Address - Fax:
Practice Address - Street 1:A050 UNIVERSITY HOSPITAL- PHARMACY
Practice Address - Street 2:50 N MEDICAL DR
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT147593-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist