Active NPI
Kelly Diesterhaft, PHARMD
- Pharmacist
- Salt Lake City, UT
National Provider Identifier
1710254875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 7317273-1701
- Practice address
- 3730 W 4700 S
Salt Lake City, UT 84129-3457 - Phone
- (801) 213-9200
- NPI assigned
- Nov 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7317273-1701 | UT | Primary |
Addresses
Primary practice location
3730 W 4700 S
Salt Lake City, UT 84129-3457
Mailing address
3730 West 4700 South
West Valley City, UT 84118
Phone (801) 213-9200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7317273-1701 | UT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321488000000",
"number": "1710254875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3730 WEST 4700 SOUTH",
"city": "WEST VALLEY CITY",
"state": "UT",
"postal_code": "84118",
"telephone_number": "801-213-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3730 W 4700 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841293457",
"telephone_number": "801-213-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIESTERHAFT",
"first_name": "KELLY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-17",
"last_updated": "2011-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "UT",
"license": "7317273-1701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.