Provider Demographics
NPI:1285739961
Name:THAXTON, PATRICIA (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:THAXTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 KAIBAB CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2309
Mailing Address - Country:US
Mailing Address - Phone:801-673-8391
Mailing Address - Fax:
Practice Address - Street 1:3652 KAIBAB CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-2309
Practice Address - Country:US
Practice Address - Phone:801-673-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1515151701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist