Healthcare Provider Details

I. General information

NPI: 1609609817
Provider Name (Legal Business Name): NICHOLAS ALAN COLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 S REDWOOD RD
WEST JORDAN UT
84084-5518
US

IV. Provider business mailing address

16137 S TRUSS DR
BLUFFDALE UT
84065-1868
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-9077
  • Fax:
Mailing address:
  • Phone: 480-710-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14141298-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: