Provider Demographics
NPI:1295336402
Name:DAVIES, BRENNON SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRENNON
Middle Name:SCOTT
Last Name:DAVIES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W 3775 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4795
Mailing Address - Country:US
Mailing Address - Phone:801-787-1403
Mailing Address - Fax:
Practice Address - Street 1:1851 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4125
Practice Address - Country:US
Practice Address - Phone:435-789-9787
Practice Address - Fax:435-789-1310
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8088042-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist