MEDICARE: ENOCH MUSSER WAYMAN 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	7456902-1701	UT
2	183500000X	Pharmacist	S024007	AZ

General Provider Information

NPI Number	:	1548875396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENOCH MUSSER WAYMAN PHARMD

Provider Business Mailing Address
First Line	:	1388 S 1000 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-2133
Country	:	US
Telephone Number	:	801-906-9030
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 N CENTRAL ST UNIT 6
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-6134
Country	:	US
Telephone Number	:	801-906-9030
Fax Number	:

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

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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