=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730471566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY DAVID NILSON PHARMD, BCPS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11520 S REDWOOD RD
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-887-7353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 W FROST DR
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84025-2966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-451-5396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 4849680-1701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------