Healthcare Provider Details

I. General information

NPI: 1609739010
Provider Name (Legal Business Name): NATHANIEL W DOTSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 E 3900 S
SALT LAKE CITY UT
84124-1412
US

IV. Provider business mailing address

1251 W WIMBLEDON RIDGE LN
WEST JORDAN UT
84084-3503
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-1300
  • Fax:
Mailing address:
  • Phone: 435-691-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7450898-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: