Provider Demographics
NPI:1609422310
Name:GARCIA, JAYME ANN HENRIETTA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:ANN HENRIETTA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8493 S 6070 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3448
Mailing Address - Country:US
Mailing Address - Phone:951-264-1311
Mailing Address - Fax:
Practice Address - Street 1:1550 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-5105
Practice Address - Country:US
Practice Address - Phone:801-974-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8088152-17013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy