Provider Demographics
NPI:1184795601
Name:WIGHT, DANIEL LEE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:WIGHT
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 200 W
Mailing Address - Street 2:APARTMENT 7
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2500
Mailing Address - Country:US
Mailing Address - Phone:435-723-8321
Mailing Address - Fax:
Practice Address - Street 1:425 E 5350 S
Practice Address - Street 2:SUITE 110
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6946
Practice Address - Country:US
Practice Address - Phone:801-479-9645
Practice Address - Fax:801-475-6404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5249119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist