DR. KELLY DIESTERHAFT (NPI# 1710254875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710254875 |
| Entity Type | Individual |
| Full Name | DR. KELLY DIESTERHAFT |
| Credential | PHARMD |
| Practice Address |
3730 W 4700 S Salt Lake City UT 84129-3457 |
| Mailing Address |
3730 West 4700 South West Valley City UT 84118 |
| Practice Telephone | 8012139200 |
| Mailing Telephone | 8012139200 |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2011-11-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 7317273-1701 | UT | Pharmacy Service Providers |
| Street Address |
3730 W 4700 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84129-3457 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124457312 | Karen Marie Stagnaro | Registered Nurse | 3730 W 4700 S, Salt Lake City, UT 84129-3457 | 2013-11-07 |
| 1174684898 | John Reschke | Dentist | 3730 W 4700 S, Salt Lake City, UT 84118-3457 | 2006-12-13 |
| 1881784403 | Gordon Sherman Park | Obstetrics & Gynecology | 3730 W 4700 S, Salt Lake City, UT 84129-3457 | 2006-10-13 |
| 1265546998 | Sue Sherman | Pharmacist | 3730 W 4700 S, Salt Lake City, UT 84118-3457 | 2006-08-19 |
| 1437168184 | Seth Freeman Whatcott | Pharmacist | 3730 W 4700 S, Salt Lake City, UT 84118-3457 | 2006-08-05 |
| 1477584332 | Cynthia Lynn Gellner | Pediatrics | 3730 W 4700 S, Salt Lake City, UT 84129-3457 | 2006-07-06 |
| 1659353084 | Fay Chu Lee | Pharmacist | 3730 W 4700 S, Salt Lake City, UT 84118-3457 | 2005-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891140331 | Caring for Kearns | Social Worker | 5525 S 4015 W, Suite #207 A & B, Taylorsville, UT 84129 | 2016-05-03 |
| 1386014116 | Rusty Scott Burns | Physician Assistant | 4745 South 3200 West, Oquirrh View Clinic, Taylorsville, UT 84129 | 2015-10-06 |
| 1013398817 | Clifford Simpson | Counselor | 4897 S Avant Cir, Taylorsville, UT 84129 | 2015-06-17 |
| 1912328576 | Heather Jenkins | Substance Abuse Rehabilitation Facility | 6200 South 3809 West, Kearns, UT 84129 | 2013-12-30 |
| 1184981201 | Intermountain Community Supports and Services, LLC | In Home Supportive Care | 5104 Heritage Cove, Taylorsville, UT 84129 | 2012-04-13 |
| 1093039521 | Chad Alan Spain | Family Medicine | 3745 West 4700 South, Family Practice, Taylorsville, UT 84129 | 2010-03-26 |
| 1396068342 | Lindsay Helena Wilson | Dermatology | 3845 West 4700 South, Intermountain Healthcare Taylorsville Clinic, Taylorsville, UT 84129 | 2010-03-04 |
| 1962962407 | Craig J Campbell Dpm PC | Durable Medical Equipment & Medical Supplies | 5255 S 4015 W, #140, Salt Lake City, UT 84129 | 2019-03-21 |
| 1851866735 | Katie Nicholls | Physician Assistant | 4745 S 3200 W, Taylorsville, UT 84129 | 2018-10-08 |
| 1073954996 | Alexander Maxwell Dahmen | Social Worker | 1760 West 4805 South, Taylorsville, UT 84129 | 2013-07-08 |
| Find all providers in zip 84129 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245830108 | Chadwick M Smith | Pharmacist | 7494 S 2135 E, Salt Lake City, UT 84121-4970 | 2020-10-29 |
| 1568074318 | Kelli Thorup | Pharmacist | 458 E Emerson Ave, Salt Lake City, UT 84115-1531 | 2020-08-21 |
| 1376154435 | James Lindsay Clark | Pharmacist | 201 S 1300 E Ste 101, Salt Lake City, UT 84102-2608 | 2020-08-12 |
| 1699392530 | Rebecca Lavasani | Pharmacist | 1813 E Orchard Dr, Salt Lake City, UT 84106-3258 | 2020-06-26 |
| 1912541772 | Alesia Lynne Hanson | Pharmacist | 2233 S Presidents Dr Ste B, Salt Lake City, UT 84120-7244 | 2019-11-04 |
| 1316596554 | Adam Davies | Pharmacist | 1280 E Stringham Ave., Salt Lake City, UT 84106 | 2019-09-10 |
| 1346899085 | Nathan Wilson | Pharmacist | 1950 Circle of Hope Dr Ste N1780, Salt Lake City, UT 84112-5500 | 2019-09-05 |
| 1437711918 | Hillary Hansen Parkin | Pharmacist | 85 N Medical Dr, Salt Lake City, UT 84112-1100 | 2019-07-03 |
| 1972087328 | Reza Salman | Pharmacist | 4720 S Fortuna Way, Salt Lake City, UT 84124-5620 | 2018-09-21 |
| 1801373022 | John Gardner | Pharmacist | 1280 E Stringham Ave, Salt Lake City, UT 84106-2490 | 2018-07-20 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84129 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.