Provider Demographics
NPI:1821153222
Name:OMER, DEBRA ALICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ALICE
Last Name:OMER
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 1:187 E 1050 N
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1246
Mailing Address - Country:US
Mailing Address - Phone:801-547-1037
Mailing Address - Fax:
Practice Address - Street 1:1915 W 5950 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1454
Practice Address - Country:US
Practice Address - Phone:801-387-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144872-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist