Healthcare Provider Details

I. General information

NPI: 1467401547
Provider Name (Legal Business Name): ALISSA NIELSEN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W 880 N
OREM UT
84057
US

IV. Provider business mailing address

PO BOX 137
MORONI UT
84646-0137
US

V. Phone/Fax

Practice location:
  • Phone: 435-436-8363
  • Fax:
Mailing address:
  • Phone: 435-436-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number346608-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: