Provider Demographics
NPI:1962139147
Name:THOMPSON, BRYAN GARTH (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:GARTH
Last Name:THOMPSON
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 1:3955 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-3307
Mailing Address - Country:US
Mailing Address - Phone:801-966-1497
Mailing Address - Fax:801-957-8134
Practice Address - Street 1:3955 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-3307
Practice Address - Country:US
Practice Address - Phone:801-966-1497
Practice Address - Fax:801-957-8134
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5410433-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist