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General NPI Number Information
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NPI Number | 1235206459
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Entity Type | Individual
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Provider Name | DANA K. NIELSON PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 65 S MAIN ST
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City | BLANDING
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State | UT
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Zip | 84511-3742
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Country | US
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Telephone | 435-678-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 455 CEDAR CIR # 42-9
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City | BLANDING
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State | UT
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Zip | 84511-4026
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Country | US
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Telephone | 435-678-2525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 142481-1701
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License Number State | UT
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