Provider Demographics
NPI:1225639792
Name:BARSEGIAN, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BARSEGIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 E TREE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2534
Mailing Address - Country:US
Mailing Address - Phone:801-274-0384
Mailing Address - Fax:
Practice Address - Street 1:4627 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4879
Practice Address - Country:US
Practice Address - Phone:801-268-1818
Practice Address - Fax:801-261-3869
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT337414-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist