# A&W PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A&W Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740692367
- **Authorized official:** WADE POULSON RPH (OWNER, PIC)
- **Authorized official phone:** (435) 738-3784

## Contact information

- **Practice address:** 171 E MAIN ST, DUCHESNE, UT 84021
- **Practice address phone:** (435) 738-3784
- **Practice address fax:** (435) 738-3785
- **Mailing address:** 171 E MAIN ST, PO BOX 997, DUCHESNE, UT 84021-0997
- **Mailing address phone:** (435) 738-3784
- **Mailing address fax:** (435) 738-3785

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 89320161703 | UT | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/02/2014
- **Last updated:** 01/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1740692367 | — | UT |
| 01 | — | 2143889 | PK | — |