Organization
A&W PHARMACY
Active
Other names
A&W Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WADE POULSON RPH (OWNER, PIC)
(435) 738-3784
Entity
Organization
Contact information
Practice address
171 E MAIN ST, DUCHESNE, UT 84021
(435) 738-3784
(435) 738-3785
Mailing address
171 E MAIN ST, PO BOX 997, DUCHESNE, UT 84021-0997
(435) 738-3784
(435) 738-3785
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
89320161703
UT
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740692367
—
UT
01
—
2143889
PK
—
Enumeration date
06/02/2014
Last updated
01/26/2015
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