Provider Demographics
NPI:1720594476
Name:FORSYTH, ZACHARY JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:JOSEPH
Last Name:FORSYTH
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 1:1105 S 840 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2422
Mailing Address - Country:US
Mailing Address - Phone:435-669-6394
Mailing Address - Fax:435-635-4938
Practice Address - Street 1:25 N 2000 W STE 1
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-4112
Practice Address - Country:US
Practice Address - Phone:435-635-8200
Practice Address - Fax:435-635-8200
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7684261-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist