Provider Demographics
NPI:1841831674
Name:HUSSEY, BRIAN COOPER
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:COOPER
Last Name:HUSSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 N 550 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2284
Mailing Address - Country:US
Mailing Address - Phone:435-881-6320
Mailing Address - Fax:
Practice Address - Street 1:4275 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3101
Practice Address - Country:US
Practice Address - Phone:801-479-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5629248-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist