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General NPI Number Information
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NPI Number | 1184367757
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Entity Type | Individual
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Provider Name | JONATHAN RANDALL WARREN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 1208 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84404-5743
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Country | US
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Telephone | 801-621-1367
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Fax |
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Provider Business Mailing Address
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Address Line | 2365 S 2885 W
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City | SYRACUSE
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State | UT
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Zip | 84075-7031
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Country | US
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Telephone | 385-985-7897
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 104781781701
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License Number State | UT
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