Provider Demographics
NPI:1942458872
Name:MOULTON, MEGAN RENEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RENEE
Last Name:MOULTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2284
Mailing Address - Country:US
Mailing Address - Phone:801-766-0355
Mailing Address - Fax:
Practice Address - Street 1:760 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2284
Practice Address - Country:US
Practice Address - Phone:801-766-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56341201701183500000X
IDP6097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist