Healthcare Provider Details

I. General information

NPI: 1548802481
Provider Name (Legal Business Name): NANCY LYNN NEWSOM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 E 800 S
SALT LAKE CITY UT
84102-3634
US

IV. Provider business mailing address

876 E 800 S
SALT LAKE CITY UT
84102-3634
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-5257
  • Fax: 801-363-6731
Mailing address:
  • Phone: 801-355-5257
  • Fax: 801-363-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number323584-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: