Provider Demographics
NPI:1700167186
Name:GREENWOOD, BRONSTON M II (RPH)
Entity Type:Individual
Prefix:
First Name:BRONSTON
Middle Name:M
Last Name:GREENWOOD
Suffix:II
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 1:5483 S 925 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7047
Mailing Address - Country:US
Mailing Address - Phone:801-476-3277
Mailing Address - Fax:
Practice Address - Street 1:1962 W 1800 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8328
Practice Address - Country:US
Practice Address - Phone:801-614-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142453-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT142453-1701OtherLICENSE