MEDICARE: RICHARD H ENSIGN II PHARMD

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	151727-1701	UT

General Provider Information

NPI Number	:	1174699573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD H ENSIGN II PHARMD

Provider Business Mailing Address
First Line	:	1979 HILL ST
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-9536
Country	:	US
Telephone Number	:	801-444-1689
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 S STATE ST
Second Line	:	SUITE 1700
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1401
Country	:	US
Telephone Number	:	801-442-3232
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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