Provider Demographics
NPI:1396106373
Name:VAWDREY, ERIC (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VAWDREY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1215
Mailing Address - Country:US
Mailing Address - Phone:801-792-6813
Mailing Address - Fax:435-654-2890
Practice Address - Street 1:550 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:UT
Practice Address - Zip Code:84032-1215
Practice Address - Country:US
Practice Address - Phone:801-792-6813
Practice Address - Fax:435-654-2890
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6432788-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist