Provider Demographics
NPI:1679461503
Name:BAWDEN, REUEL JAY
Entity type:Individual
Prefix:
First Name:REUEL
Middle Name:JAY
Last Name:BAWDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6846
Mailing Address - Country:US
Mailing Address - Phone:435-915-4224
Mailing Address - Fax:435-915-4215
Practice Address - Street 1:1160 N 1000 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6846
Practice Address - Country:US
Practice Address - Phone:435-915-4224
Practice Address - Fax:435-915-4215
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143524-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist