Healthcare Provider Details

I. General information

NPI: 1609407840
Provider Name (Legal Business Name): TIMOTHY PULLEYN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 N 175 E
LOGAN UT
84321-5570
US

IV. Provider business mailing address

2200 US HIGHWAY 50 E
DAYTON NV
89403-7352
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-6570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9239397-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: