MEDICARE: DR. MICHAEL DOUGLASS WRIGHT 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	183500000X	Pharmacist	6277546-1701	UT

General Provider Information

NPI Number	:	1720467871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DOUGLASS WRIGHT PHARM D.

Provider Business Mailing Address
First Line	:	1671 E REDONDO AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3826
Country	:	US
Telephone Number	:	801-558-1968
Fax Number	:	801-935-4000

Provider Business Practice Location Address
First Line	:	1671 E REDONDO AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3826
Country	:	US
Telephone Number	:	801-558-1968
Fax Number	:	801-935-4000

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

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	05/22/2015

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