MR. Evan Dale Theobald, PHARMACIST

NPI #1952497604 in Provo, Utah

Provider Information

NPI Number: 1952497604
Entity Type: Individual
Name: MR. Evan Dale Theobald, PHARMACIST
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Credential: PHARMACIST
Enumeration Date: Oct 4, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1034 NORTH 500 WEST
City: Provo
State: Utah
ZIP Code: 84604
Phone: (801) 357-7051

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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