Provider Demographics
NPI:1548717390
Name:BUDKE, SETH ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ALEXANDER
Last Name:BUDKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SETH
Other - Middle Name:
Other - Last Name:BUDKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1066 BARLEY LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6793
Mailing Address - Country:US
Mailing Address - Phone:801-809-9640
Mailing Address - Fax:
Practice Address - Street 1:1066 BARLEY LN
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6793
Practice Address - Country:US
Practice Address - Phone:801-809-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8665028-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist