NPIMap

Organization Active NPI

A&W Pharmacy

  • Community/Retail Pharmacy
  • Duchesne, UT
National Provider Identifier
1740692367
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
89320161703 Issued in UT
Legal business name
A&W PHARMACY
Doing business as
A&W Pharmacy
Practice address
171 E Main St
Duchesne, UT 84021
Phone
(435) 738-3784
Fax
(435) 738-3785
NPI assigned
Jun 2, 2014
Last updated
Jan 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wade Poulson, RPH
Title
Owner, Pic
Phone
(435) 738-3784

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 89320161703 UT Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

171 E Main St
Duchesne, UT 84021

Mailing address

171 E Main St
PO Box 997
Duchesne, UT 84021-0997
Phone (435) 738-3784

Other identifiers 2

IdentifierTypeStateIssuer
1740692367MedicaidUT
2143889OtherPK

Other names 1

  • A&W Pharmacy Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1740692367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 E MAIN ST",
            "address_2": "PO BOX 997",
            "city": "DUCHESNE",
            "state": "UT",
            "postal_code": "840210997",
            "telephone_number": "435-738-3784",
            "fax_number": "435-738-3785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 E MAIN ST",
            "city": "DUCHESNE",
            "state": "UT",
            "postal_code": "84021",
            "telephone_number": "435-738-3784",
            "fax_number": "435-738-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A&W PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "POULSON",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "OWNER, PIC",
        "authorized_official_telephone_number": "435-738-3784",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "89320161703",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740692367",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143889",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A&W Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duchesne, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.