Provider Demographics
NPI:1689444101
Name:SPECKMAN, MICHELLE DENAE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENAE
Last Name:SPECKMAN
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 1:4133 W PIONEER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2059
Mailing Address - Country:US
Mailing Address - Phone:801-403-4934
Mailing Address - Fax:888-546-0632
Practice Address - Street 1:4133 W PIONEER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2059
Practice Address - Country:US
Practice Address - Phone:801-403-4934
Practice Address - Fax:888-546-0632
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333237-17011835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care