Provider Demographics
NPI:1770185597
Name:DURRANT, JEFFREY DAVIS
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVIS
Last Name:DURRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 W 8010 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4322
Mailing Address - Country:US
Mailing Address - Phone:801-913-3207
Mailing Address - Fax:
Practice Address - Street 1:99 W 1280 N
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9093
Practice Address - Country:US
Practice Address - Phone:435-882-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70961591701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist