Healthcare Provider Details

I. General information

NPI: 1598636581
Provider Name (Legal Business Name): NICKOLAS VAMIANAKIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11925 S STATE ST
DRAPER UT
84020-7735
US

IV. Provider business mailing address

11925 S STATE ST
DRAPER UT
84020-7735
US

V. Phone/Fax

Practice location:
  • Phone: 801-545-8160
  • Fax: 801-545-8166
Mailing address:
  • Phone: 801-545-8160
  • Fax: 801-545-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5282523-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: