Provider Demographics
NPI:1881321206
Name:SHCHEGLOVITOVA, OLESYA (RPH)
Entity type:Individual
Prefix:
First Name:OLESYA
Middle Name:
Last Name:SHCHEGLOVITOVA
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 1:4675 S HOLLADAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5268
Mailing Address - Country:US
Mailing Address - Phone:385-257-8310
Mailing Address - Fax:385-257-8311
Practice Address - Street 1:4675 S HOLLADAY BLVD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5268
Practice Address - Country:US
Practice Address - Phone:385-257-8310
Practice Address - Fax:385-257-8311
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10462674-1701183500000X
UT104626741701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10462674-1701Medicaid
UT104626741701Medicaid