MEDICARE: DAVID BRENT WEBB 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	P6979	ID
2	183500000X	Pharmacist	6370797-1701	UT
3	183500000X	Pharmacist	18291	NV

General Provider Information

NPI Number	:	1568062081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BRENT WEBB PHARMD

Provider Business Mailing Address
First Line	:	7970 S BROKEN RIDGE DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84094-7203
Country	:	US
Telephone Number	:	775-443-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 S 4000 W
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-6232
Country	:	US
Telephone Number	:	801-969-1424
Fax Number	:	801-969-8116

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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