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NPI Code Detail

MEDICARE: BRONSTON M GREENWOOD II RPH

MEDICARE: BRONSTON M GREENWOOD II RPH
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
1183500000XPharmacist142453-1701UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1142453-1701OTHERUTLICENSE

General Provider Information

NPI Number : 1700167186
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRONSTON M GREENWOOD II RPH
Provider Business Mailing Address
First Line : 5483 S 925 E
Second Line :
City : SOUTH OGDEN
State : UT
Zip : 84405-7047
Country : US
Telephone Number : 801-476-3277
Fax Number :
Provider Business Practice Location Address
First Line : 1962 W 1800 N
Second Line :
City : CLINTON
State : UT
Zip : 84015-8328
Country : US
Telephone Number : 801-614-1347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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