Healthcare Provider Details

I. General information

NPI: 1225995905
Provider Name (Legal Business Name): LISA NIELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 E 600 N
BOUNTIFUL UT
84010-1744
US

IV. Provider business mailing address

725 N REDWOOD RD
NORTH SALT LAKE UT
84054-2832
US

V. Phone/Fax

Practice location:
  • Phone: 385-243-8144
  • Fax: 385-243-8144
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number330507-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: