Provider Demographics
NPI:1124620521
Name:LAMOREAUX, HEATH
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:
Last Name:LAMOREAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9211
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-0211
Mailing Address - Country:US
Mailing Address - Phone:801-815-0551
Mailing Address - Fax:
Practice Address - Street 1:6545 N LANDMARK DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5990
Practice Address - Country:US
Practice Address - Phone:435-647-9050
Practice Address - Fax:435-647-9042
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5304530-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist