Jeremy Kim Burtenshaw, PHARM.D.
Individual provider Active NPI Pharmacist · Roy, UT
NPI 1295043255 · NPPES record last updated Sep 23, 2010
Key facts
- NPI
- 1295043255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 6651223-1701 (UT)
- Practice address
- 5450 S 2150 W
Roy, UT 84067-2155 - Phone
- (801) 678-2971
- NPI assigned
- Sep 23, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6651223-1701 | UT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6651223-1701 | UT | Yes |
Addresses
Primary practice location
5450 S 2150 W
Roy, UT 84067-2155
Mailing address
5450 S 2150 W
Roy, UT 84067-2155
Other providers in Roy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2010. 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.