Healthcare Provider Details

I. General information

NPI: 1922133982
Provider Name (Legal Business Name): BERNT ROAR NIELSEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 N STATE ST
OREM UT
84057-3149
US

IV. Provider business mailing address

2222 E 1480 S
SPANISH FORK UT
84660-6435
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-4621
  • Fax:
Mailing address:
  • Phone: 801-794-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2774244-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: