Provider Demographics
NPI:1992112221
Name:ALLDREDGE, JOSHUA (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ALLDREDGE
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 1:120 E 550 N APT 1
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6064
Mailing Address - Country:US
Mailing Address - Phone:801-694-1351
Mailing Address - Fax:
Practice Address - Street 1:200 N MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1752
Practice Address - Country:US
Practice Address - Phone:801-292-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6296131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist