Healthcare Provider Details

I. General information

NPI: 1790901908
Provider Name (Legal Business Name): NATHAN ADAMS PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N STATE ST
MORGAN UT
84050-9569
US

IV. Provider business mailing address

PO BOX 1109
MORGAN UT
84050-1109
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-6271
  • Fax:
Mailing address:
  • Phone: 801-829-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5950819-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: