Provider Demographics
NPI:1972820389
Name:CARPENTER, KATHLEEN ANN (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:CARPENTER
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 1:4040 W 5415 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4308
Mailing Address - Country:US
Mailing Address - Phone:801-982-1912
Mailing Address - Fax:
Practice Address - Street 1:4040 W 5415 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-4308
Practice Address - Country:US
Practice Address - Phone:801-982-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT99-342382-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist