Provider Demographics
NPI:1366099087
Name:KUNZLER, CHRISTIE LYN
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYN
Last Name:KUNZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WILLOWMERE DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-8000
Mailing Address - Country:US
Mailing Address - Phone:801-458-8984
Mailing Address - Fax:
Practice Address - Street 1:217 N 2000 W
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-8026
Practice Address - Country:US
Practice Address - Phone:385-383-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360886-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT360886-1701OtherSTATE LICENSE