Provider Demographics
NPI:1235206459
Name:NIELSON, DANA K (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:K
Last Name:NIELSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CEDAR CIR # 42-9
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-4026
Mailing Address - Country:US
Mailing Address - Phone:435-678-2525
Mailing Address - Fax:
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3742
Practice Address - Country:US
Practice Address - Phone:435-678-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142481-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist