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General NPI Number Information
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NPI Number | 1396055042
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Entity Type | Individual
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Provider Name | JESSE LEE MAUGHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 1080 S HWY 118
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City | RICHFIELD
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State | UT
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Zip | 84701
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Country | US
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Telephone | 435-896-8489
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 332
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City | ANNABELLA
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State | UT
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Zip | 84711-0332
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Country | US
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Telephone | 435-760-3504
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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 | 5887548-1701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5887548-8911
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License Number State | UT
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