Provider Demographics
NPI:1982781118
Name:VAGSTAD, ROBERT GRAHAM (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GRAHAM
Last Name:VAGSTAD
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 1:2294 E 10000 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4127
Mailing Address - Country:US
Mailing Address - Phone:801-942-0784
Mailing Address - Fax:
Practice Address - Street 1:1055 DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9094
Practice Address - Country:US
Practice Address - Phone:801-571-0112
Practice Address - Fax:801-571-1350
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325758-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist