MEDICARE: RONALD HENRY ENGBERSON PHARM-D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1778	AK
2	183500000X	Pharmacist	19482	NV

General Provider Information

NPI Number	:	1376844779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD HENRY ENGBERSON PHARM-D

Provider Business Mailing Address
First Line	:	132 E SEGO LILY DR APT 105
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4260
Country	:	US
Telephone Number	:	907-250-4933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2224
Country	:	US
Telephone Number	:	702-474-0259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	12/27/2020

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