=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497878367
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICK CARLSON PHARMD, BCPS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2007
-----------------------------------------------------
Last Update Date | 04/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8721 S 4680 W
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84088-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-349-0422
-----------------------------------------------------
Fax | 801-507-5578
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8721 S 4680 W
-----------------------------------------------------
City | WEST JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84088-4923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-349-0422
-----------------------------------------------------
Fax | 801-507-5578
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 501060-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------