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General NPI Number Information
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NPI Number | 1316988835
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Entity Type | Individual
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Provider Name | PEGGY BAKKE NICHOLSON R.PH
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1380 E MEDICAL CENTER DR
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City | ST GEORGE
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State | UT
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Zip | 84790-2123
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Country | US
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Telephone | 435-251-2400
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Fax | 435-251-2413
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Provider Business Mailing Address
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Address Line | 1337 W 1200 N
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City | ST GEORGE
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State | UT
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Zip | 84770-4921
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Country | US
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Telephone | 435-628-7449
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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 | 146430-1701
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License Number State | UT
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