Healthcare Provider Details

I. General information

NPI: 1023975554
Provider Name (Legal Business Name): NATHAN ELMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12831 S 2200 W
RIVERTON UT
84065-6734
US

IV. Provider business mailing address

12831 S 2200 W
RIVERTON UT
84065-6734
US

V. Phone/Fax

Practice location:
  • Phone: 385-266-5461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14258307-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: