Provider Demographics
NPI:1235023698
Name:GONZALEZ, JARED ALEX (PHARMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:ALEX
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JARED
Other - Middle Name:ALEX
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:497 W 4800 S STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4749
Mailing Address - Country:US
Mailing Address - Phone:801-810-0337
Mailing Address - Fax:801-801-3128
Practice Address - Street 1:497 W 4800 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-4749
Practice Address - Country:US
Practice Address - Phone:801-810-0337
Practice Address - Fax:801-312-8760
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0025138183500000X
UT8786745-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist