| NPI | 1659786341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN WILSON Pharmacist 801-521-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7960198-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0007741) |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2014-06-22 |