Provider Demographics
NPI:1528151388
Name:NIELSON'S PHARMACY, INC
Entity type:Organization
Organization Name:NIELSON'S PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WESTIN
Authorized Official - Middle Name:KASH
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-381-5464
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0556
Mailing Address - Country:US
Mailing Address - Phone:435-381-5464
Mailing Address - Fax:435-381-5316
Practice Address - Street 1:590 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513-4503
Practice Address - Country:US
Practice Address - Phone:435-381-5464
Practice Address - Fax:435-381-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128662-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870424807001Medicare ID - Type Unspecified