Provider Demographics
NPI:1063140796
Name:HSIEH, HENRY (PHARMD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:HSIEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 W 8390 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-7916
Mailing Address - Country:US
Mailing Address - Phone:801-664-9491
Mailing Address - Fax:
Practice Address - Street 1:3540 S 4000 W STE 430
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3246
Practice Address - Country:US
Practice Address - Phone:801-957-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10493497-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10493497-1701OtherUT DOPL - PHARMACIST LICENSE
10493497-8911OtherUT DOPL - PHARMACIST CONTROLLED SUBSTANCE LICENSE