Richard Grant Ballam, RPH
Individual provider Active NPI Pharmacist · Layton, UT
NPI 1376136010 · NPPES record last updated Feb 13, 2021
Key facts
- NPI
- 1376136010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 146100-1701 (UT)
- Practice address
- 1356 E Highway 193
Layton, UT 84040-8533 - Phone
- (801) 771-2994
- Fax
- (801) 771-2996
- NPI assigned
- Feb 13, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146100-1701 | UT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past |
Accepting new patients | |
| Walmart Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 146100-1701 | UT | Yes |
Addresses
Primary practice location
1356 E Highway 193
Layton, UT 84040-8533
Mailing address
1356 E Highway 193
Layton, UT 84040-8533
Phone (801) 771-2994
Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2021. 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.