MEDICARE: MR. SAMUEL CHASE WARNER 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	1835P2201X	Ambulatory Care Pharmacist	7058070	UT

General Provider Information

NPI Number	:	1053785386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL CHASE WARNER PHARM D.

Provider Business Mailing Address
First Line	:	2029 E STRATFORD DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1710
Country	:	US
Telephone Number	:	801-907-1386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2366
Country	:	US
Telephone Number	:	801-484-8782
Fax Number	:

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

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	11/24/2015

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