Provider Demographics
NPI:1609918382
Name:WEBER, MICHAEL J (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WEBER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EAST 200 SOUTH
Mailing Address - Street 2:
Mailing Address - City:DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84021-0003
Mailing Address - Country:US
Mailing Address - Phone:801-574-8957
Mailing Address - Fax:435-738-5405
Practice Address - Street 1:50 EAST 200 SOUTH
Practice Address - Street 2:
Practice Address - City:DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84021
Practice Address - Country:US
Practice Address - Phone:435-738-5403
Practice Address - Fax:435-735-5405
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT294596-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063651669OtherDVMC PHARMACY NPI
UT870276435Medicaid