Provider Demographics
NPI:1851666507
Name:PAPENFUSS, PHILLIP ALMA (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALMA
Last Name:PAPENFUSS
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 1:11100 S. AUTO MALL DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4171
Mailing Address - Country:US
Mailing Address - Phone:801-790-0002
Mailing Address - Fax:801-790-0009
Practice Address - Street 1:11100 S. AUTO MALL DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4171
Practice Address - Country:US
Practice Address - Phone:801-790-0002
Practice Address - Fax:801-790-0009
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355721-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist