1285852392 NPI number — DR. ALICIA KIM GARDINER PHARMD

Table of content: DR. ALICIA KIM GARDINER PHARMD (NPI 1285852392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285852392 NPI number — DR. ALICIA KIM GARDINER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDINER
Provider First Name:
ALICIA
Provider Middle Name:
KIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDINER-BRAEGGER
Provider Other First Name:
ALICIA
Provider Other Middle Name:
KIM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285852392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 NO 70 EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERICAN FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-492-1241
Provider Business Mailing Address Fax Number:
801-855-2938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1159 E 200 NO
Provider Second Line Business Practice Location Address:
STE 125
Provider Business Practice Location Address City Name:
AMERICAN FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-855-2935
Provider Business Practice Location Address Fax Number:
801-855-2938
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  2755461701 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com