MEDICARE: RUSSELL WARD 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	7783249-1701	UT

General Provider Information

NPI Number	:	1811619786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL WARD PHARM D

Provider Business Mailing Address
First Line	:	890 S MAIN ST
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-2463
Country	:	US
Telephone Number	:	435-654-0414
Fax Number	:	435-657-1972

Provider Business Practice Location Address
First Line	:	890 S MAIN ST
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-2463
Country	:	US
Telephone Number	:	435-654-0414
Fax Number	:	435-657-1972

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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