Healthcare Provider Details

I. General information

NPI: 1063661593
Provider Name (Legal Business Name): REUBEN KENRICK NIELSEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 S 900 E
MURRAY UT
84121-1034
US

IV. Provider business mailing address

5658 MARCO RD
MURRAY UT
84121-1070
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-1025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number336267-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: