Provider Demographics
NPI:1740576636
Name:ALLEN, MINDY (RPH)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ALLEN
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 1:815 W 2000 N
Mailing Address - Street 2:T-1755
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1632
Mailing Address - Country:US
Mailing Address - Phone:801-773-6478
Mailing Address - Fax:801-773-6478
Practice Address - Street 1:815 W 2000 N
Practice Address - Street 2:T-1755
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1632
Practice Address - Country:US
Practice Address - Phone:801-773-6478
Practice Address - Fax:801-773-6478
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27745811701183500000X
UT27745818911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist