MEDICARE: ROBERT JAMES VICKERS 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	355389-1701	UT

General Provider Information

NPI Number	:	1982097606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JAMES VICKERS PHARMD

Provider Business Mailing Address
First Line	:	91 N MAIN ST
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-2648
Country	:	US
Telephone Number	:	435-586-9651
Fax Number	:	435-586-3473

Provider Business Practice Location Address
First Line	:	91 N MAIN ST
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-2648
Country	:	US
Telephone Number	:	435-586-9651
Fax Number	:	435-586-3473

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

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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