Anthony Matthew Mazza, RPH
Individual provider Active NPI Pharmacist · Sunset, UT
NPI 1124579313 · NPPES record last updated Oct 22, 2016
Key facts
- NPI
- 1124579313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5039647-1701 (UT)
- Practice address
- 2353 N Main St
Sunset, UT 84015-2454 - Phone
- (801) 825-2262
- Fax
- (801) 773-3989
- NPI assigned
- Oct 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5039647-1701 | UT | MD | Pharmacist |
| 3916 | WY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smith'S Food & Drug Centers Inc | Past | Accepting new patients | |
| Smiths Food & Drug Centers Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5039647-1701 | UT | Yes |
| Pharmacist | 183500000X | 3916 | WY |
Addresses
Primary practice location
2353 N Main St
Sunset, UT 84015-2454
Mailing address
1566 34TH St
Ogden, UT 84403-1366
Phone (801) 627-8573
Other providers in Sunset, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.