Provider Demographics
NPI:1770184194
Name:GARN, DEREK DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DANIEL
Last Name:GARN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 ARIANE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3462
Mailing Address - Country:US
Mailing Address - Phone:801-707-1828
Mailing Address - Fax:
Practice Address - Street 1:221 W PARRISH LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1829
Practice Address - Country:US
Practice Address - Phone:801-294-6168
Practice Address - Fax:801-294-6171
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5057183500000X
UT152961-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist