Provider Demographics
NPI:1992027098
Name:VERIDICUS CONSULTING
Entity Type:Organization
Organization Name:VERIDICUS CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURGOYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:801-865-1997
Mailing Address - Street 1:4190 HIGHLAND DR
Mailing Address - Street 2:# 250
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2600
Mailing Address - Country:US
Mailing Address - Phone:801-865-1997
Mailing Address - Fax:
Practice Address - Street 1:4190 HIGHLAND DR
Practice Address - Street 2:# 250
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-2600
Practice Address - Country:US
Practice Address - Phone:801-865-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27556317013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy