Mark C Koelliker

NPI #1922642198 in Midvale, Utah

Provider Information

NPI Number: 1922642198
Entity Type: Individual
Name: Mark C Koelliker
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Oct 31, 2019
Last Updated: Oct 31, 2019

Practice Location

Address: 980 E FORT UNION BLVD
City: Midvale
State: Utah
ZIP Code: 84047-1714
Phone: (801) 256-0532

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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