Provider Demographics
NPI:1164266870
Name:STUCKI, MICHAEL JARED (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JARED
Last Name:STUCKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 N AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5168
Mailing Address - Country:US
Mailing Address - Phone:801-494-3627
Mailing Address - Fax:
Practice Address - Street 1:4045 E PONY EXPRESS PKWY
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5512
Practice Address - Country:US
Practice Address - Phone:801-789-4997
Practice Address - Fax:801-789-4993
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10694183500000X
UT9101904-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist