Healthcare Provider Details

I. General information

NPI: 1174699573
Provider Name (Legal Business Name): RICHARD H ENSIGN II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S STATE ST SUITE 1700
SALT LAKE CITY UT
84111-1401
US

IV. Provider business mailing address

1979 HILL ST
KAYSVILLE UT
84037-9536
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-3232
  • Fax:
Mailing address:
  • Phone: 801-444-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number151727-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: