Healthcare Provider Details

I. General information

NPI: 1568831881
Provider Name (Legal Business Name): NICKOLAS JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 S 900 W
SALT LAKE CITY UT
84104-1455
US

IV. Provider business mailing address

5346 W CASE MOUNTAIN RD
WEST JORDAN UT
84081-3931
US

V. Phone/Fax

Practice location:
  • Phone: 801-364-2564
  • Fax: 801-363-4633
Mailing address:
  • Phone: 801-364-2564
  • Fax: 801-363-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8418441-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: