Provider Demographics
NPI:1962782672
Name:ZOLA, TOMASZ (PHARMD)
Entity type:Individual
Prefix:
First Name:TOMASZ
Middle Name:
Last Name:ZOLA
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 1:11406 GRACEY LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5462
Mailing Address - Country:US
Mailing Address - Phone:801-523-6267
Mailing Address - Fax:
Practice Address - Street 1:176 E 13800 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9548
Practice Address - Country:US
Practice Address - Phone:801-307-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6583658-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist