Healthcare Provider Details

I. General information

NPI: 1205482270
Provider Name (Legal Business Name): JASON ATKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 W 600 N
SALT LAKE CITY UT
84116-2676
US

IV. Provider business mailing address

1174 W 600 N
SALT LAKE CITY UT
84116-2676
US

V. Phone/Fax

Practice location:
  • Phone: 801-363-1047
  • Fax:
Mailing address:
  • Phone: 801-363-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number370960-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: