Provider Demographics
NPI:1710741061
Name:WOOD, COLLIN BRADLEY (CPHT)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:BRADLEY
Last Name:WOOD
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 W 2000 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1638
Mailing Address - Country:US
Mailing Address - Phone:801-614-1302
Mailing Address - Fax:
Practice Address - Street 1:1171 W 2000 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1638
Practice Address - Country:US
Practice Address - Phone:801-614-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11500819183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician