Provider Demographics
NPI:1467844480
Name:NASIR, TUFAN
Entity type:Individual
Prefix:
First Name:TUFAN
Middle Name:
Last Name:NASIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 W WASATCH ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7627
Mailing Address - Country:US
Mailing Address - Phone:385-321-2784
Mailing Address - Fax:
Practice Address - Street 1:669 W 900 N
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2602
Practice Address - Country:US
Practice Address - Phone:222-888-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT72670571701183500000X
UT72670578911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist