MEDICARE: NIELSON'S PHARMACY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	128662-1703	UT

General Provider Information

NPI Number	:	1528151388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIELSON'S PHARMACY, INC

Provider Business Mailing Address
First Line	:	PO BOX 556
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513-0556
Country	:	US
Telephone Number	:	435-381-5464
Fax Number	:	435-381-5316

Provider Business Practice Location Address
First Line	:	590 E MAIN ST
Second Line	:
City	:	CASTLE DALE
State	:	UT
Zip	:	84513-4503
Country	:	US
Telephone Number	:	435-381-5464
Fax Number	:	435-381-5316

Authorized Official
Title or Position	:	PIC/MANAGER
Name	:	WESTIN KASH WINN
Credential	:	PHARMD
Telephone Number	:	435-381-5464

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/08/2023

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