Provider Demographics
NPI:1700430865
Name:MCHARGUE, BRYAN REED
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:REED
Last Name:MCHARGUE
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 1:1510 W 1200 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3204
Mailing Address - Country:US
Mailing Address - Phone:801-367-1660
Mailing Address - Fax:
Practice Address - Street 1:931 W STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2102
Practice Address - Country:US
Practice Address - Phone:801-796-6580
Practice Address - Fax:801-795-0760
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT501326-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist