Provider Demographics
NPI:1023229184
Name:ANDERSON, JUDITH (RPH)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ANDERSON
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 1:8394 SNOW BASIN DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1035
Mailing Address - Country:US
Mailing Address - Phone:801-942-4675
Mailing Address - Fax:801-943-9859
Practice Address - Street 1:2378 FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3339
Practice Address - Country:US
Practice Address - Phone:801-943-2446
Practice Address - Fax:801-943-9859
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143746-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist