Provider Demographics
NPI:1568771350
Name:NIKOLA, SUSAN LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:NIKOLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 APPIAN CV
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-2218
Mailing Address - Country:US
Mailing Address - Phone:801-942-0071
Mailing Address - Fax:
Practice Address - Street 1:8745 S. HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-942-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145470-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist