Healthcare Provider Details

I. General information

NPI: 1508053232
Provider Name (Legal Business Name): IRVIN NIELS NIELSEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIV HOSPITAL PHARMACY 50 NORTH MEDICAL DRIVE
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

790 E 8080 S
SANDY UT
84094-0633
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2147
  • Fax: 801-585-0403
Mailing address:
  • Phone: 801-561-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number143052
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: