MEDICARE: MR. CHARLES R WILLIE RPH

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	144363-1701	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417970419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES R WILLIE RPH

Provider Business Mailing Address
First Line	:	134 W 2225 N
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84043-2835
Country	:	US
Telephone Number	:	801-768-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	5353 W 11000 N
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9403
Country	:	US
Telephone Number	:	801-756-8353
Fax Number	:	801-756-3525

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/09/2007

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