Provider Demographics
NPI:1215254370
Name:MATSON, KARILYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KARILYN
Middle Name:
Last Name:MATSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 E 3210 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-8410
Mailing Address - Country:US
Mailing Address - Phone:801-860-4999
Mailing Address - Fax:
Practice Address - Street 1:2545 E 3210 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2700
Practice Address - Country:US
Practice Address - Phone:801-860-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5872655-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist