Provider Demographics
NPI:1629526736
Name:GEORGE, JONATHAN WESLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WESLEY
Last Name:GEORGE
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 1:5448 W DAYBREAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5901
Mailing Address - Country:US
Mailing Address - Phone:801-501-7180
Mailing Address - Fax:801-501-7185
Practice Address - Street 1:5448 W DAYBREAK PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5901
Practice Address - Country:US
Practice Address - Phone:801-501-7180
Practice Address - Fax:801-501-7185
Is Sole Proprietor?:No
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5543677-1701183500000X
WY3876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist