Provider Demographics
NPI:1821303579
Name:KILPATRICK, LAYNE R (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAYNE
Middle Name:R
Last Name:KILPATRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1344
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1344
Mailing Address - Country:US
Mailing Address - Phone:801-278-9008
Mailing Address - Fax:801-849-0399
Practice Address - Street 1:392 E 12300 S
Practice Address - Street 2:SUITE A
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8181
Practice Address - Country:US
Practice Address - Phone:801-278-9008
Practice Address - Fax:801-849-0399
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151154-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist