Provider Demographics
NPI:1063512614
Name:DELOST, KORT H (RPH)
Entity type:Individual
Prefix:
First Name:KORT
Middle Name:H
Last Name:DELOST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E 500 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6227
Mailing Address - Country:US
Mailing Address - Phone:801-295-3463
Mailing Address - Fax:801-298-8223
Practice Address - Street 1:47 E 500 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6227
Practice Address - Country:US
Practice Address - Phone:801-295-3463
Practice Address - Fax:801-298-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146840-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist