Wade R Poulson
Organization Active NPI Pharmacy · Duchesne, UT
NPI 1154640555 · NPPES record last updated Nov 12, 2010
Key facts
- NPI
- 1154640555
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- WADE R POULSON
- Practice address
- 1322 N Scotch Pine Dr
Duchesne, UT 84021-0464 - Phone
- (435) 738-0155
- Fax
- (435) 738-0153
- NPI assigned
- May 25, 2010
- Organization subpart
- No
Authorized official
- Name
- Wade Poulson
- Title
- Owner
- Phone
- (801) 389-0267
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1322 N Scotch Pine Dr
Duchesne, UT 84021-0464
Mailing address
PO Box 464
Duchesne, UT 84021-0464
Phone (801) 389-0267
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4611833 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- Scotch Pine Pharmacy
Other providers in Duchesne, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.